Active NPI
Kenji Grant Beppu, DDS, MSD
- Endodontics
- Bellevue, WA
National Provider Identifier
1225163033
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- DE00008581
- Practice address
- 14595 Bel Red Rd
Suite #103
Bellevue, WA 98007-3928 - Phone
- (425) 562-9070
- NPI assigned
- Feb 22, 2007
- Last updated
- Jul 8, 2007
- 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 |
|---|---|---|---|---|
| Endodontics | 1223E0200X | DE00008581 | WA | Primary |
Addresses
Primary practice location
14595 Bel Red Rd
Suite #103
Bellevue, WA 98007-3928
Mailing address
14595 Bel Red Rd
Suite #103
Bellevue, WA 98007-3928
Phone (425) 562-9070
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 10, 2020 through Apr 10, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DE00008581 | WA | MD | Endodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172102400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1225163033",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14595 BEL RED RD",
"address_2": "SUITE #103",
"city": "BELLEVUE",
"state": "WA",
"postal_code": "980073928",
"telephone_number": "425-562-9070"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14595 BEL RED RD",
"address_2": "SUITE #103",
"city": "BELLEVUE",
"state": "WA",
"postal_code": "980073928",
"telephone_number": "425-562-9070"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BEPPU",
"first_name": "KENJI",
"middle_name": "GRANT",
"name_prefix": "Dr.",
"credential": "DDS, MSD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "WA",
"license": "DE00008581",
"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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.