Shamina Khanum, DENTIST
NPI 1053724120ActiveIndividual· Dentist, General Practice· Jackson, MS
Dentist, General Practice (DENTIST) in Jackson, Mississippi, licensed in MS, with an NPI issued in June 2014. Enrolled in Medicare as practitioner - dentist.
Overview
| NPI | 1053724120 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | DENTIST |
| Sole proprietor | No |
| NPI issued | Jun 6, 2014 |
| Last updated in NPPES | Jan 15, 2025 |
| Certified by provider | Jan 17, 2023 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Dentist, General Practice Primary | 1223G0001X | 4090-19 | MS |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Dentist (MS) |
|---|
Education and affiliations
| Graduation year | 1997 |
|---|---|
| Medicare specialty | Dentist |
Industry payments (Open Payments)
None reported for 2025 or 2024.
Receiving payments does not imply wrongdoing. What Open Payments covers ·original records
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