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Deactivated NPI 1669468500 Deactivated / Inactive NPI Male Practitioner

Dr. Kiumars Elyasi , DDS

Dentist - General Practice • Jessup, MD

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Kiumars Elyasi has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date September 26, 2005
NPI Deactivation Date March 24, 2006
Total Practice Duration ~1 Years of Practice (2005 – 2006)

Professional Overview & Biography Verified Profile Summary

Dr. Kiumars Elyasi, DDS was a registered Dentist - General Practice practicing in Jessup, MD. Throughout an active medical career spanning 1 years, Dr. Elyasi provided care at the practice location at 8450 DORSEY RUN RD until profile deactivation on 2006-03-24.

Practice Location & Contact Primary Location

Practice Address

8450 Dorsey Run Rd

Jessup, MD 207949486

Telephone 4107243153
Associated Practice Facility / Clinic

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in Jessup, MD

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 14.2 Yrs
Regional Practice Density
3 Specialists

Practicing in Jessup, MD (2555 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

State License MD 10612

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

38 Associated Practitioners
Kathjia Demaisip , OTR, L

Occupational Therapist

NPI 1003732678

Occupational Therapist Registered, L

Ashley Devine

Social Worker - Clinical

NPI 1033039268
NPI 1134048556

Licensed Master Social Worker

Dr. Khalid El-Sayed , MD

Student in an Organized Health Care Education/Training Program

NPI 1134323694

Doctor of Medicine (M.D.)

Craig Madiou , LCSW-C

Social Worker - Clinical

NPI 1154011724

Licensed Clinical Social Worker - Certified

Rachelle Mechaly

Social Worker - Clinical

NPI 1174440374

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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Updated Practice Location July 08, 2007

Registered at 8450 DORSEY RUN RD, JESSUP, MD 207949486 (Tel: 4107243153)

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Updated Business Mailing Address July 08, 2007

Registered at 2023 GEORGE WASHINGTON RD, VIENNA, VA 221823711 (Tel: 7037342023)

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Provider Name / Credentials Updated July 08, 2007

Recorded as KIUMARS ELYASI, D.D.S.

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Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Dentist (License #10612 in MD)

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NPI Profile Reactivated April 05, 2006

Record officially reactivated for active practice on April 05, 2006

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NPI Profile Deactivated March 24, 2006

Record deactivated on March 24, 2006

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Initial NPI Registration & Enumeration September 26, 2005

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1669468500
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: September 26, 2005
Last Update: July 13, 2026
Deactivation Date: March 24, 2006
Sole Proprietor: No

Mailing Address

2023 George Washington Rd

Vienna, VA 221823711

Phone: 7037342023

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

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