NPIMap

Organization Active NPI

Totem Lake Pediatrics

  • Clinic/Center
  • Kirkland, WA
National Provider Identifier
1376706028
Registry record updated Jul 2, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
MD00029356 Issued in WA
Legal business name
TOTEM LAKE PEDIATRICS
Practice address
13128 Totem Lake Blvd NE Ste 105
Kirkland, WA 98034-2953
Phone
(425) 899-4570
NPI assigned
Jul 2, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2008

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

Authorized official

Name
Dr. Firoz IbrahimNPI 1669588240
Title
Owner
Phone
(425) 899-4570

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
Clinic/Center 261Q00000X MD00029356 WA Primary

Addresses

Primary practice location

13128 Totem Lake Blvd NE Ste 105
Kirkland, WA 98034-2953

Mailing address

13128 Totem Lake Blvd NE Ste 105
Kirkland, WA 98034-2953
Phone (425) 899-4570

Other identifiers 1

IdentifierTypeStateIssuer
1078922MedicaidWA

National Provider Directory

National Provider Directory

Locations

13128 Totem Lake Blvd NE
Ste 105
Kirkland, WA 98034
Phone (425) 899-4570

Practitioners & affiliated clinicians

Practitioners 1

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": "1214956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214956800000",
    "number": "1376706028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13128 TOTEM LAKE BLVD NE STE 105",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980342953",
            "telephone_number": "425-899-4570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13128 TOTEM LAKE BLVD NE STE 105",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980342953",
            "telephone_number": "425-899-4570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TOTEM LAKE PEDIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-02",
        "last_updated": "2008-07-02",
        "status": "A",
        "authorized_official_last_name": "IBRAHIM",
        "authorized_official_first_name": "FIROZ",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "425-899-4570",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "WA",
            "license": "MD00029356",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1078922",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kirkland, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.