Individual provider Active NPI

Kamran Fotoohi, DDS

  • Dentist
  • Everett, WA
National Provider Identifier
1164089769
Registry record updated Jun 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DE61052139 Issued in WA
Practice address
1019 112TH St SW
Everett, WA 98204-4875
Phone
(425) 551-6200
NPI assigned
May 20, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DE61052139 WA Primary
General Practice Dentistry 1223G0001X DE61052139 WA

Addresses

Primary practice location

1019 112TH St SW
Everett, WA 98204-4875

Mailing address

1019 112TH St SW
Everett, WA 98204-4875

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DE61052139WAMDGeneral Practice Dentistry

Interoperability endpoints

  • Direct secure messaging: kfotoohi598982@direct.ochin.org

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1558310400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780444800000",
    "number": "1164089769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1019 112TH ST SW",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982044875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1019 112TH ST SW",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982044875",
            "telephone_number": "425-551-6200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOTOOHI",
        "first_name": "KAMRAN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-05-20",
        "last_updated": "2026-06-03",
        "certification_date": "2026-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE61052139",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE61052139",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Everett, WA

Sources for this page

Verify at the official NPI Registry.