Individual provider Active NPI

Kamaran Shemshaki, DMD

  • Dentist
  • Mercer Island, WA
National Provider Identifier
1053423632
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DE8047 Issued in WA
Practice address
2955 80TH Ave SE
Suite #203
Mercer Island, WA 98040
Phone
(206) 236-2681
Fax
(206) 236-7221
NPI assigned
Aug 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DE8047 WA Primary

Addresses

Primary practice location

2955 80TH Ave SE
Suite #203
Mercer Island, WA 98040

Mailing address

18516 NE 26 Street
Redmond, WA 98052
Phone (425) 881-9414

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181217002596 WA Order and Referring Only - DentistPractitioner - Dentist 3274878418

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DE8047WAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Kamran Shemshaki, DMD, PS CurrentSince Oct 8, 2023 Accepting new patients

Locations

14150 NE 20th St
Ste F2
Bellevue, WA 98007
Phone (425) 614-1515

Networks

  • WA PPO C-SNP

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1053423632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18516 NE 26 STREET",
            "city": "REDMOND",
            "state": "WA",
            "postal_code": "98052",
            "telephone_number": "425-881-9414",
            "fax_number": "425-881-9414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2955 80TH AVE SE",
            "address_2": "SUITE #203",
            "city": "MERCER ISLAND",
            "state": "WA",
            "postal_code": "98040",
            "telephone_number": "206-236-2681",
            "fax_number": "206-236-7221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEMSHAKI",
        "first_name": "KAMARAN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE8047",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mercer Island, WA

Sources for this page

Verify at the official NPI Registry.