Individual provider Active NPI

Aaron Van Wong, DDS

  • Dentist
  • Seattle, WA
National Provider Identifier
1194945675
Registry record updated Nov 11, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DE00009435 Issued in WA
Practice address
10521 Meridian Ave N
Seattle, WA 98133-9509
Phone
(206) 296-4990
Fax
(206) 205-5142
NPI assigned
Apr 26, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 11, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DE00009435 WA Primary

Addresses

Primary practice location

10521 Meridian Ave N
Seattle, WA 98133-9509

Mailing address

PO Box 3835
Seattle, WA 98124-3835
Phone (206) 548-3114

Other identifiers 1

IdentifierTypeStateIssuer
5048913MedicaidWA

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160307002428 WA Order and Referring Only - DentistPractitioner - Dentist 8224334974

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Aaron Van Wong DDS PLLC Current Accepting new patients

Locations

12199 Village Center Pl
Ste 204
Mukilteo, WA 98275
Phone (425) 349-5600

Organizations & group practices 1

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": "1177545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478822400000",
    "number": "1194945675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3835",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981243835",
            "telephone_number": "206-548-3114",
            "fax_number": "206-762-6355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10521 MERIDIAN AVE N",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981339509",
            "telephone_number": "206-296-4990",
            "fax_number": "206-205-5142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WONG",
        "first_name": "AARON",
        "middle_name": "VAN",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-26",
        "last_updated": "2016-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE00009435",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5048913",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.