Active NPI
Jeric-Kai Dasalla Bongolan
- Community Health Worker
- Spokane, WA
National Provider Identifier
1326849142
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- Practice address
- 731 N Iron Bridge Way
Spokane, WA 99202-4926 - Phone
- (509) 444-8888
- NPI assigned
- Mar 19, 2025
- 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 |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | Primary |
Addresses
Primary practice location
731 N Iron Bridge Way
Spokane, WA 99202-4926
Mailing address
611 N Iron Bridge Way
Spokane, WA 99202-4932
Phone (509) 444-8888
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1742342400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1742342400000",
"number": "1326849142",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "611 N IRON BRIDGE WAY",
"city": "SPOKANE",
"state": "WA",
"postal_code": "992024932",
"telephone_number": "509-444-8888"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "731 N IRON BRIDGE WAY",
"city": "SPOKANE",
"state": "WA",
"postal_code": "992024926",
"telephone_number": "509-444-8888"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BONGOLAN",
"first_name": "JERIC-KAI",
"middle_name": "DASALLA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-03-19",
"last_updated": "2025-03-19",
"certification_date": "2025-03-19",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Spokane, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.