Active NPI
Kim S. Mallick, M.D., P.S.
- Ophthalmology Physician
- Seattle, WA
National Provider Identifier
1508078320
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- MD00027008
- Legal business name
- KIM S. MALLICK, M.D., P.S.
- Practice address
- 1221 Madison St
Suite 1218
Seattle, WA 98104-1356 - Phone
- (206) 215-2323
- Fax
- (206) 215-2320
- NPI assigned
- May 4, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Kim Shannon Mallick, M.D.
- Title
- President
- Phone
- (206) 215-2323
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | MD00027008 | WA | Primary |
Addresses
Primary practice location
1221 Madison St
Suite 1218
Seattle, WA 98104-1356
Mailing address
1221 Madison St
Suite 1218
Seattle, WA 98104-1356
Phone (206) 215-2323
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1078542 | Medicaid | WA | |
| 32114 | Other | WA | LABOR AND INDUSTRIES |
National Provider Directory
National Provider DirectoryLocations
1221 Madison St
Ste 1218
Seattle, WA 98104
Phone (206) 215-2323
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Ophthalmology Physician
- Seattle, WA
- NPI 1952523219
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178236800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1508078320",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1221 MADISON ST",
"address_2": "SUITE 1218",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981041356",
"telephone_number": "206-215-2323",
"fax_number": "206-215-2320"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1221 MADISON ST",
"address_2": "SUITE 1218",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981041356",
"telephone_number": "206-215-2323",
"fax_number": "206-215-2320"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "KIM S. MALLICK, M.D., P.S.",
"organizational_subpart": "NO",
"enumeration_date": "2007-05-04",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "MALLICK",
"authorized_official_first_name": "KIM",
"authorized_official_middle_name": "SHANNON",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "206-215-2323",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Ophthalmology",
"state": "WA",
"license": "MD00027008",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1078542",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LABOR AND INDUSTRIES",
"identifier": "32114",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Seattle, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.