Tarja Kaakko

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

9397 Issued in WA

Practice address

700 NW Gilman Blvd
Suite E-103, #493
Issaquah, WA 98027-5395

Phone

(206) 355-1596

Fax

(425) 369-9785

NPI assigned

Nov 22, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Pacific Childrens Dentistry

  • Pediatric Dentistry
  • Everett, WA
  • NPI 1407126873
  NPD (past) Authorized official

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

{
    "created_epoch": "1164153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1215734400000",
    "number": "1306911383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 NW GILMAN BLVD",
            "address_2": "SUITE E-103, #493",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980275395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 NW GILMAN BLVD",
            "address_2": "SUITE E-103, #493",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980275395",
            "telephone_number": "206-355-1596",
            "fax_number": "425-369-9785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAAKKO",
        "first_name": "TARJA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-22",
        "last_updated": "2008-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "WA",
            "license": "9397",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5056239",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5040324",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer An-Jeng Juang, O.D.
• Judith Mendenhall, MSW, Licsw, PLLC
• Julie P. Franke, Licsw, PLLC
• Jhansi Juluri
• JWSC PLLC (Squak Mountain Chiropractic & Rehab)
• Krystal Kaald, L.M.P.
• Michelle L Kahle, PA-C
• Kelsey Anne Kairis, DO
• Carol Ann Kakoczky, LMP
• Irina Kamatcho, MA, LMHC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2008; 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.