Active NPI
Jaesun Lee Dahlke
- Pharmacy Technician
- Lynnwood, WA
National Provider Identifier
1104509033
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy Technician
- Practice address
- 2902 164TH St SW
Lynnwood, WA 98087-3201 - Phone
- (425) 787-4900
- NPI assigned
- Aug 8, 2023
- 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 |
|---|---|---|---|---|
| Pharmacy Technician | 183700000X | Primary |
Addresses
Primary practice location
2902 164TH St SW
Lynnwood, WA 98087-3201
Mailing address
16629 44TH Ave W
Lynnwood, WA 98037-3127
Phone (206) 539-6595
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1691452800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1691452800000",
"number": "1104509033",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16629 44TH AVE W",
"city": "LYNNWOOD",
"state": "WA",
"postal_code": "980373127",
"telephone_number": "206-539-6595"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2902 164TH ST SW",
"city": "LYNNWOOD",
"state": "WA",
"postal_code": "980873201",
"telephone_number": "425-787-4900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAHLKE",
"first_name": "JAESUN",
"middle_name": "LEE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-08-08",
"last_updated": "2023-08-08",
"certification_date": "2023-08-08",
"status": "A"
},
"taxonomies": [
{
"code": "183700000X",
"taxonomy_group": "",
"desc": "Pharmacy Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lynnwood, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.