NPIMap

Organization Active NPI

Ear Nose and Throat Associates Southwest Inc PS

  • Otolaryngology Physician
  • Olympia, WA
National Provider Identifier
1376306852
Registry record updated Feb 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
Legal business name
EAR NOSE AND THROAT ASSOCIATES SOUTHWEST INC PS
Practice address
128 Lilly Rd NE Ste 202
Olympia, WA 98506-7400
Phone
(360) 357-6314
Fax
(360) 705-3745
NPI assigned
Feb 6, 2024
Organization subpart
Yes
Parent organization
EAR NOSE AND THROAT ASSOCIATES SOUTHWEST INC PSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 6, 2024

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

Authorized official

Name
Sung-Won Kim, MDNPI 1558577627
Title
Ceo
Phone
(360) 357-6314

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Y00000X Primary

Addresses

Primary practice location

128 Lilly Rd NE Ste 202
Olympia, WA 98506-7400

Mailing address

128 Lilly Rd NE Ste 202
Olympia, WA 98506-7400
Phone (360) 357-6314

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031226000116 WA Part B Supplier - Clinic/Group Practice 5294633400 Receives reassigned benefits from 6 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Olympia, WA

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Ear Nose Throat Associa

Locations

128 Lilly Rd NE
Olympia, WA 98506
Phone (360) 357-6314

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1707177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707177600000",
    "number": "1376306852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "128 LILLY RD NE STE 202",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985067400",
            "telephone_number": "360-357-6314",
            "fax_number": "360-705-3745"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 LILLY RD NE STE 202",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985067400",
            "telephone_number": "360-357-6314",
            "fax_number": "360-705-3745"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAR NOSE AND THROAT ASSOCIATES SOUTHWEST INC PS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EAR NOSE AND THROAT ASSOCIATES SOUTHWEST INC PS",
        "enumeration_date": "2024-02-06",
        "last_updated": "2024-02-06",
        "certification_date": "2024-02-06",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "SUNG-WON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "360-357-6314",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Olympia, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.