=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205049707
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YATIN KHANNA DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2007
-----------------------------------------------------
Last Update Date | 05/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 506 6TH ST
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11215-3609
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-915-3713
-----------------------------------------------------
Fax | 866-894-5881
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 RIVER CT APARTMENT 2206
-----------------------------------------------------
City | JERSEY CITY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07310-2001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-915-3713
-----------------------------------------------------
Fax | 866-894-5881
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0700X
-----------------------------------------------------
Taxonomy Name | Prosthodontics
-----------------------------------------------------
License Number | 053649
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223P0700X
-----------------------------------------------------
Taxonomy Name | Prosthodontics
-----------------------------------------------------
License Number | 22DI02350900
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------