Active NPI
Michael Cohen, DDS, MSD
- Periodontics
- Kenmore, WA
National Provider Identifier
1053463901
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 4692
- Practice address
- 5723 NE Bothell Way
Suite C
Kenmore, WA 98028-9404 - Phone
- (425) 486-9111
- Fax
- (425) 489-1923
- NPI assigned
- Jan 18, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 4692 | WA | Primary |
Addresses
Primary practice location
5723 NE Bothell Way
Suite C
Kenmore, WA 98028-9404
Mailing address
5723 NE Bothell Way
Suite C
Kenmore, WA 98028-9404
Phone (425) 486-9111
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4692 | Other | WA | WDS # |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4692 | WA | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169078400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1053463901",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5723 NE BOTHELL WAY",
"address_2": "SUITE C",
"city": "KENMORE",
"state": "WA",
"postal_code": "980289404",
"telephone_number": "425-486-9111",
"fax_number": "425-489-1923"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5723 NE BOTHELL WAY",
"address_2": "SUITE C",
"city": "KENMORE",
"state": "WA",
"postal_code": "980289404",
"telephone_number": "425-486-9111",
"fax_number": "425-489-1923"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COHEN",
"first_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "DDS, MSD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "WA",
"license": "4692",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WDS #",
"identifier": "4692",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kenmore, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.