Active NPI
Peeyush Ranjan
- Pediatric Dentistry
- Longview, WA
National Provider Identifier
1063056711
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- DE61007218
- Practice address
- 1717 Olympia Way
Longview, WA 98632-3929 - Phone
- (360) 636-1900
- NPI assigned
- Nov 5, 2019
- 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 |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | DE61007218 | WA | Primary |
Addresses
Primary practice location
1717 Olympia Way
Longview, WA 98632-3929
Mailing address
1717 Olympia Way
Longview, WA 98632-3929
Phone (360) 636-1900
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DE61007218 | WA | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1572912000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1572912000000",
"number": "1063056711",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1717 OLYMPIA WAY",
"city": "LONGVIEW",
"state": "WA",
"postal_code": "986323929",
"telephone_number": "360-636-1900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1717 OLYMPIA WAY",
"city": "LONGVIEW",
"state": "WA",
"postal_code": "986323929",
"telephone_number": "360-636-1900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RANJAN",
"first_name": "PEEYUSH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-11-05",
"last_updated": "2019-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "WA",
"license": "DE61007218",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Longview, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.