MS. SHAMINA KHANUM DENTIST
NPI 1053724120
Dentist - General Practice in Jackson, MS

Q: What is Shamina Khanum's NPI number?

The NPI number for Shamina Khanum is 1053724120. It was assigned to this individual provider in the NPPES registry on June 6, 2014.

Q: What is Shamina Khanum's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Q: When was this NPI record last updated?

The NPPES record for Shamina Khanum was last updated on January 15, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since June 06, 2014PECOS Enrolled

3502 WEST NORTHSIDE DRIVE, JACKSON, MS 39213(601) 362-5321(601) 364-2600 Get Directions Write a Review

NPPES record last updated: January 15, 2025. Verified against the NPPES registry weekly; last sync: August 30, 2026.

Record update history: Jan 17, 2023, Aug 29, 2022, Jul 30, 2021 and 1 more (4 updates tracked since 2020).

On this page

About Ms. Shamina Khanum Dentist NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MS. SHAMINA KHANUM DENTIST (NPI 1053724120) is an individual general practice provider in Jackson, Mississippi, licensed in Mississippi (4090-19) and active in the NPI registry since June 2014. She is enrolled in Medicare PECOS and is a graduate of Other (1997).

NPPES Registry Identity

NPI1053724120

Entity TypeIndividualFemale

Primary Taxonomy1223G0001X

Provider Legal NameMS. SHAMINA KHANUMCredential: DENTIST

Location Address3502 WEST NORTHSIDE DRIVEJackson, MS 39213

Mailing Address3502 West Northside Drive, Jackson Hinds ComprehensiveTupelo, MS 38801 · (601) 362-5321 · Fax (601) 364-2600

Phone(601) 362-5321

Fax(601) 364-2600

Sole ProprietorNo

Medical School CMSOtherGraduated 1997

Enumeration DateJune 6, 2014

Last NPPES UpdateJanuary 15, 20254 updates tracked since enumeration

NPPES CertifiedJanuary 17, 2023

✔ NPI 1053724120 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers

Taxonomy Code1223G0001X

License✔ Licensed in MS · 4090-19

Definition

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.

3502 WEST NORTHSIDE DRIVE, Jackson, MS 39213

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter from Magnolia Health and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Ms. Shamina Khanum Dentist is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID5799189015

PECOS Enrollment IDI20251028000029

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 39213 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$80.50 typical visit price

range $51.65 – $159.18

Typical copayment $20.12 (range $12.91 – $39.79)

Most-billed visit code 99203

Established Patient

$64.96 typical visit price

range $16.15 – $129.61

Typical copayment $16.24 (range $4.03 – $32.40)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shamina Khanum's NPI number?

The NPI number for Shamina Khanum is 1053724120. It was assigned to this individual provider in the NPPES registry on June 6, 2014.

Where is Shamina Khanum located?

Shamina Khanum practices at 3502 West Northside Drive, Jackson, MS 39213. The listed phone number is (601) 362-5321.

What is Shamina Khanum's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Is Shamina Khanum enrolled in Medicare?

Yes. Shamina Khanum is registered in the Medicare PECOS enrollment system.

What insurance does Shamina Khanum accept?

Health plans from Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter from Magnolia Health, Ambetter of Alabama and Ambetter of Tennessee and 13 other insurers list Shamina Khanum as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Shamina Khanum was last updated on January 15, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.