Individual provider Active NPI

Kim Alan McGinnis, DDS

  • General Practice Dentistry
  • Everett, WA
National Provider Identifier
1285630640
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DE00005733 Issued in WA
Practice address
2121 Madison St
Ste B
Everett, WA 98203-5375
Phone
(425) 353-3210
Fax
(425) 355-7426
NPI assigned
Jun 21, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DE00005733 WA Primary

Addresses

Primary practice location

2121 Madison St
Ste B
Everett, WA 98203-5375

Mailing address

2121 Madison St
Ste B
Everett, WA 98203-5375
Phone (425) 353-3210

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
I20200827003170 WA Practitioner - Dentist 0446540488 Practice locations: Everett, WA

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DE00005733WAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Kim Alan McGinnis DDS General Practice Current Accepting new patients

Locations

2121 Madison St
Ste B
Everett, WA 98203
Phone (425) 353-3210

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": "1119312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1285630640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2121 MADISON ST",
            "address_2": "STE B",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982035375",
            "telephone_number": "425-353-3210",
            "fax_number": "425-355-7426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 MADISON ST",
            "address_2": "STE B",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982035375",
            "telephone_number": "425-353-3210",
            "fax_number": "425-355-7426"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCGINNIS",
        "first_name": "KIM",
        "middle_name": "ALAN",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-21",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE00005733",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Everett, WA

Sources for this page

Verify at the official NPI Registry.