Active NPI
Kam Derakshani, DDS
- General Practice Dentistry
- Bellevue, WA
National Provider Identifier
1104849900
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(2) exclusion effective Oct 20, 2015.
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DE7712
- Practice address
- 1551 116TH Ave. NE
#B-1
Bellevue, WA 98004 - Phone
- (425) 373-1605
- NPI assigned
- Jul 25, 2006
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DE7712 | WA | Primary |
Addresses
Primary practice location
1551 116TH Ave. NE
#B-1
Bellevue, WA 98004
Mailing address
1551 116TH Ave NE Ste B1
Bellevue, WA 98004-3814
Phone (425) 373-1605
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
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DE7712 | WA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153785600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1239753600000",
"number": "1104849900",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1551 116TH AVE NE STE B1",
"city": "BELLEVUE",
"state": "WA",
"postal_code": "980043814",
"telephone_number": "425-373-1605"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1551 116TH AVE. NE",
"address_2": "#B-1",
"city": "BELLEVUE",
"state": "WA",
"postal_code": "98004",
"telephone_number": "425-373-1605"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DERAKSHANI",
"first_name": "KAM",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-25",
"last_updated": "2009-04-15",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "WA",
"license": "DE7712",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bellevue, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.