Kincaid, McClary & Kim D.D.S, P.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DE00003702 Issued in WA

Legal business name

KINCAID, MCCLARY & KIM D.D.S, P.S.

Practice address

16410 Smokey Point Blvd
Suite 103
Arlington, WA 98223-8415

Phone

(360) 658-8822

Fax

(360) 659-1275

NPI assigned

May 27, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Diana Lynn Plymale

Title

Administration

Phone

(360) 651-1359

Specialties & licenses 6

Addresses

Other identifiers 1

Other names 1

• Kincaid, McClary & Zysset D.D.D. P.S. Former legal business name

Locations

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Daniel Thomas Brady, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Arlington, WA
  • NPI 1376725499
  NPD (past)
• Michael Gross, DMD, MD

  • Oral and Maxillofacial Surgery (Dentist)
  • Arlington, WA
  • NPI 1154821924
  NPD (past)
• Peter H Kim, D.D.S.

  • Oral and Maxillofacial Surgery (Dentist)
  • Arlington, WA
  • NPI 1093858318
  NPD (past)
• Samuel A McClary, D.D.S.

  • Oral and Maxillofacial Surgery (Dentist)
  • Arlington, WA
  • NPI 1578606083
  NPD (past)
• Serv Wahan, DMD, MD

  • Oral and Maxillofacial Surgery (Dentist)
  • Kirkland, WA
  • NPI 1376564229
  NPD (past)
• Dustin R Altmann, DMD

  • Oral and Maxillofacial Surgery (Dentist)
  • Saint Louis, MO
  • NPI 1396180436
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1043267925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16410 SMOKEY POINT BLVD",
            "city": "ARLINGTON",
            "state": "WA",
            "postal_code": "982238415",
            "telephone_number": "360-658-8822",
            "fax_number": "360-659-1275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16410 SMOKEY POINT BLVD",
            "address_2": "SUITE 103",
            "city": "ARLINGTON",
            "state": "WA",
            "postal_code": "982238415",
            "telephone_number": "360-658-8822",
            "fax_number": "360-659-1275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KINCAID, MCCLARY & KIM D.D.S, P.S.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PLYMALE",
        "authorized_official_first_name": "DIANA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "ADMINISTRATION",
        "authorized_official_telephone_number": "360-651-1359",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WA",
            "license": "DE00003702",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WA",
            "license": "GA10000027",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WA",
            "license": "DE00005524",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WA",
            "license": "GA10000031",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WA",
            "license": "DE0008656",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WA",
            "license": "GA10000282",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5337704",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kincaid, McClary & Zysset D.D.D. P.S.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Edward Kim
• Hannah Linda Kim, M.D.
• Jena Kim
• Peter H Kim, D.D.S.
• Tiffanie P.O. Kimura, RDH
• Elizabeth Samantha King
• Jeremy R King, MSN, ARNP, FNP-C
• KLN Counseling PLLC
• Onna Marie Knoles
• Rebekah L. Knox, L.M.P.

• Oral and Maxillofacial Surgery (Dentist) in Arlington, WA
• Providers in Arlington, WA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.