Active NPI
Nannaput Nongnuang
- General Practice Dentistry
- Lynnwood, WA
National Provider Identifier
1508751876
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DENT.DE.70111861
- Practice address
- 16108 Ash Way Ste 202
Lynnwood, WA 98087-8781 - Phone
- (425) 741-2030
- NPI assigned
- Jun 9, 2025
- Last updated
- Sep 22, 2026
- Sex
- Unspecified or another gender identity
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DENT.DE.70111861 | WA | Primary |
Addresses
Primary practice location
16108 Ash Way Ste 202
Lynnwood, WA 98087-8781
Mailing address
7991 Upper 146TH St W
Apple Valley, MN 55124-6301
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DENT.DE.70111861 | WA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dr. Shur Dental | General Practice | Past | Accepting new patients |
| Dong Wu Han PLLC | General Practice | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1749427200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1790035200000",
"number": "1508751876",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7991 UPPER 146TH ST W",
"city": "APPLE VALLEY",
"state": "MN",
"postal_code": "551246301"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16108 ASH WAY STE 202",
"city": "LYNNWOOD",
"state": "WA",
"postal_code": "980878781",
"telephone_number": "425-741-2030"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NONGNUANG",
"first_name": "NANNAPUT",
"sole_proprietor": "NO",
"sex": "X",
"enumeration_date": "2025-06-09",
"last_updated": "2026-09-22",
"certification_date": "2026-09-22",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "WA",
"license": "DENT.DE.70111861",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lynnwood, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.