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General NPI Number Information
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NPI Number | 1871500439
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Entity Type | Individual
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Provider Name | KAUSHIK P KHAKHAR DDS
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Gender | Male
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Dates
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Enumeration Date | 08/03/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4321 GREENPOINT AVE
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City | SUNNYSIDE
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State | NY
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Zip | 11104-3605
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Country | US
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Telephone | 718-786-4175
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Fax | 718-786-7577
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Provider Business Mailing Address
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Address Line | 203 HARBOR VIEW DRIVE
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City | PORT WASHINGTON
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State | NY
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Zip | 11050
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Country | US
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Telephone | 516-767-3189
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Fax | 718-786-7577
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 033307
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License Number State | NY
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