Individual provider Active NPI

David A Kosa, DDS

  • Endodontics
  • Vancouver, WA
National Provider Identifier
1497978852
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
8903 Issued in WA
Practice address
5015 NE St Johns Rd
Vancouver, WA 98661-2348
Phone
(360) 699-1101
Fax
(360) 695-3152
NPI assigned
Apr 11, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endodontics 1223E0200X 8903 WA Primary

Addresses

Primary practice location

5015 NE St Johns Rd
Vancouver, WA 98661-2348

Mailing address

5015 NE St Johns Rd
Vancouver, WA 98661-2348
Phone (360) 699-1101

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160525002434 WA Order and Referring Only - DentistPractitioner - Dentist 5698064087

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8903WAMDEndodontist

Practice roles

OrganizationSpecialtyStatusNew patients
Columbia Endodontic Group, P.S. Endodontics Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1176249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1497978852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5015 NE ST JOHNS RD",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986612348",
            "telephone_number": "360-699-1101",
            "fax_number": "360-695-3152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5015 NE ST JOHNS RD",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986612348",
            "telephone_number": "360-699-1101",
            "fax_number": "360-695-3152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOSA",
        "first_name": "DAVID",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "WA",
            "license": "8903",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

Verify at the official NPI Registry.