Kees Peter Von Michalofski, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

DE61556534 Issued in WA

Practice address

955 Park Ave N Ste D
Renton, WA 98057-5680

Phone

(425) 793-6003

NPI assigned

Jun 21, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Practice roles

Interoperability endpoints

• Direct secure messaging: kees.vonmichalofski.p3@direct.hpc.nextgenshare.com

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.

• Washington Dental Corporation, PC

  • Dentist
  • Renton, WA
  • NPI 1164863452
  NPD (past)

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

{
    "created_epoch": "1687305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723766400000",
    "number": "1396421723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1228 NE RAVENNA BLVD",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981052616",
            "telephone_number": "509-939-4028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "955 PARK AVE N STE D",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980575680",
            "telephone_number": "425-793-6003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VON MICHALOFSKI",
        "first_name": "KEES",
        "middle_name": "PETER",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-21",
        "last_updated": "2024-08-16",
        "certification_date": "2024-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE61556534",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa 'Lee' Ann Vivanco, DNP
• Linh Van Vo, CPHT
• Thanh H Vo
• Tuong Vo
• Gale Vogeley
• Jennifer Voong
• Yekaterina Voronenko
• David Gregg Vossler, MD
• Elizabeth Charlene Voth, DPT
• Vpa PC

• Dentist in Renton, WA
• Providers in Renton, WA by specialty
• Dentist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2024; 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.