Kayla Nicole Russell Bonham, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE60865965 Issued in WA

Practice address

3819 NE 45TH St
Seattle, WA 98105-5144

Phone

(206) 524-6116

NPI assigned

Jul 17, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Feb 2, 2022 through Feb 2, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Russell & Hansen PLLC

  • General Practice Dentistry
  • Seattle, WA
  • NPI 1003971870
  NPD (past)

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

{
    "created_epoch": "1531785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648684800000",
    "number": "1508342015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3819 NE 45TH ST STE A",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981055144",
            "telephone_number": "206-524-6116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3819 NE 45TH ST",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981055144",
            "telephone_number": "206-524-6116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL BONHAM",
        "first_name": "KAYLA",
        "middle_name": "NICOLE",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-17",
        "last_updated": "2022-03-31",
        "certification_date": "2022-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE60865965",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jason M Rusk, PHARMD
• Chelsie Michelle Russ, O.D.
• Helene Gizelle Russ, PH.D.
• Yun H Russ, R.PH. BCPP
• Russell & Hansen PLLC
• Sylvia Denise Russell-Shelton, RN
• Alana Joy Russell, OTR/L
• Alexis Jeanae Russell, ARNP
• Andrea Susan Russell, LAC, MACOM
• Aspen Summit Russell

• General Practice Dentistry in Seattle, WA
• Providers in Seattle, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.