Individual provider Active NPI

Krista Kawaguchi, M.D.

  • Neurology Physician
  • Renton, WA
National Provider Identifier
1336464247
Registry record updated Mar 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
MD60299818 Issued in WA
Practice address
400 S 43Rd St
Renton, WA 98055-5714
Phone
(425) 656-5566
Fax
(425) 656-5567
NPI assigned
Apr 2, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X MD60299818 WA Primary

Addresses

Primary practice location

400 S 43Rd St
Renton, WA 98055-5714

Mailing address

3600 Lind Ave SW
Suite 100 Attn Credentialing
Renton, WA 98057-4970
Phone (425) 690-2715

Other identifiers 2

IdentifierTypeStateIssuer
G8944145OtherWAMEDICARE - VALLEY MEDICAL GROUP
2018894MedicaidWA

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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150917000225 WA Practitioner - Neurology 7315254786 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
New York University School of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Valley Medical Group-RentonGroup PAC ID 4183753965, 419 clinicians

Practice addresses (Care Compare)

400 S 43Rd St
Renton, WA 98055-5714
Phone (425) 228-3450

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD60299818WAMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Valley Medical Group-Renton Neurology CurrentSince Sep 14, 2015 Accepting new patients
Public Hospital District #1 of King County Past Accepting new patients

Locations

16850 SE 272nd St
Ste 100
Covington, WA 98042
Phone (253) 395-1971

400 S 43rd St
Renton, WA 98055
Phone (425) 228-3450

3600 Lind Ave SW
Ste 100
Renton, WA 98057

3915 Talbot Rd S
Ste 104
Renton, WA 98055
Phone (425) 656-5566

Interoperability endpoints

  • Direct secure messaging: kkawaguchi56179@direct.valleymed.org

Organizations & group practices 2

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1270166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583798400000",
    "number": "1336464247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3600 LIND AVE SW",
            "address_2": "SUITE 100 ATTN CREDENTIALING",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980574970",
            "telephone_number": "425-690-2715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 S 43RD ST",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980555714",
            "telephone_number": "425-656-5566",
            "fax_number": "425-656-5567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAWAGUCHI",
        "first_name": "KRISTA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-04-02",
        "last_updated": "2020-03-10",
        "certification_date": "2020-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "WA",
            "license": "MD60299818",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE - VALLEY MEDICAL GROUP",
            "identifier": "G8944145",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2018894",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Renton, WA

Sources for this page

Verify at the official NPI Registry.