Individual provider Active NPI

Larisa A Kaukonen, M.D.

  • Emergency Medicine Physician
  • Kirkland, WA
National Provider Identifier
1114961315
Registry record updated Dec 4, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
MD00027863 Issued in WA
Practice address
12040 NE 128TH St
Kirkland, WA 98034-3013
Phone
(425) 899-1000
NPI assigned
Jun 16, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X MD00027863 WA Primary

Addresses

Primary practice location

12040 NE 128TH St
Kirkland, WA 98034-3013

Mailing address

File 50421
Los Angeles, CA 90074-0001
Phone (800) 793-3529

Other identifiers 5

IdentifierTypeStateIssuer
KA6997OtherREGENCE BS
8126674MedicaidWA
E98234OtherGROUP HEALTH
184572OtherWA L & I
8938306OtherWA CRIME VICTIM

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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040518001138 WA Practitioner - Emergency Medicine 4688665805 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD00027863WAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
King County Public Hospital District No 2 Current Accepting new patients
King County Public Hospital District No. 2 Current Accepting new patients
King County Public Hospital District No. 2 CurrentSince Feb 5, 2014 Accepting new patients
King County Public Hospital District No 2 Current Accepting new patients
Public Hospital District No 2 CurrentSince Feb 5, 2014 Accepting new patients

Locations

1909 214th St SE
Ste 110
Bothell, WA 98021
Phone (425) 488-4988

14720 Main St NE
Ste 109
Duvall, WA 98019
Phone (425) 788-4889

12040 NE 128th St
Kirkland, WA 98034
Phone (425) 899-1000

Organizations & group practices 6

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": "1150416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196726400000",
    "number": "1114961315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "FILE 50421",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900740001",
            "telephone_number": "800-793-3529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12040 NE 128TH ST",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980343013",
            "telephone_number": "425-899-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAUKONEN",
        "first_name": "LARISA",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-16",
        "last_updated": "2007-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WA",
            "license": "MD00027863",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BS",
            "identifier": "KA6997",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8126674",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP HEALTH",
            "identifier": "E98234",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA L & I",
            "identifier": "184572",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA CRIME VICTIM",
            "identifier": "8938306",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kirkland, WA

Sources for this page

Verify at the official NPI Registry.