Kyle Clayton Kirk, DMD, MSD

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

10153 Issued in KY

Practice address

4420 106TH St SW
Mukilteo, WA 98275-4700

Phone

(253) 417-8274

NPI assigned

Apr 14, 2016

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in KY

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• University of Kentucky

  • Diagnostic Radiology Physician
  • Lexington, KY
  • NPI 1770771974

  Single Specialty

  Medicare reassignment NPD
• University of Kentucky

  • Dentist
  • Lexington, KY
  • NPI 1730225129
  NPD

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

{
    "created_epoch": "1460592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660176000000",
    "number": "1164876280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2517 SIR BARTON WAY # 200",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405092275",
            "telephone_number": "859-543-2456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4420 106TH ST SW",
            "city": "MUKILTEO",
            "state": "WA",
            "postal_code": "982754700",
            "telephone_number": "253-417-8274"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2517 Sir Barton Way # 200",
            "address_purpose": "LOCATION",
            "city": "Lexington",
            "state": "KY",
            "postal_code": "40509",
            "country_code": "US",
            "telephone_number": "859-543-2456",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6222 NE 74th St",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981158158",
            "country_code": "US",
            "telephone_number": "260-543-7906",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4420 106th St SW",
            "address_purpose": "LOCATION",
            "city": "Mukilteo",
            "state": "WA",
            "postal_code": "982754700",
            "country_code": "US",
            "telephone_number": "253-417-8274",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIRK",
        "first_name": "KYLE",
        "middle_name": "CLAYTON",
        "name_prefix": "Dr.",
        "credential": "DMD, MSD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-04-14",
        "last_updated": "2022-08-11",
        "certification_date": "2022-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "WA",
            "license": "DE60647135",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "KY",
            "license": "10153",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ting-Ting Li Kim
• Casey Jordan Kimbro, MATRN, ATC
• Carnell King
• Rachel Anne Kinney, LPN
• Jeffrey Kirby
• Breanna N Kirkhart
• Geriann Bredice Klaaskate, RPH
• Patrick Dewayne Knighton Jr., OD
• Elizabeth Rosemary Kohn, MD
• Julie Koplan, LMP

• Pediatric Dentistry in Mukilteo, WA
• Providers in Mukilteo, WA by specialty
• Pediatric Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.