Active NPI
Kenneth H Shibata, MD
- Internal Medicine Physician
- Tacoma, WA
National Provider Identifier
1528079282
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- MD00018056
- Practice address
- 1608 S J St
Floor 3
Tacoma, WA 98405-4930 - Phone
- (253) 274-7503
- Fax
- (253) 274-7993
- NPI assigned
- Aug 10, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | MD00018056 | WA | Primary |
Addresses
Primary practice location
1608 S J St
Floor 3
Tacoma, WA 98405-4930
Mailing address
1608 S J St
Floor 3
Tacoma, WA 98405-4930
Phone (253) 274-7503
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8243388 | Medicaid | WA | |
| 0223687 | Other | WA | L & I |
| 8933459 | Other | WA | CRIME VICTIMS |
| 110248736 | Other | WA | RAILROAD |
| 167254 | Other | WA | L & I |
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)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155168000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1396483200000",
"number": "1528079282",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1608 S J ST",
"address_2": "FLOOR 3",
"city": "TACOMA",
"state": "WA",
"postal_code": "984054930",
"telephone_number": "253-274-7503",
"fax_number": "253-274-7993"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1608 S J ST",
"address_2": "FLOOR 3",
"city": "TACOMA",
"state": "WA",
"postal_code": "984054930",
"telephone_number": "253-274-7503",
"fax_number": "253-274-7993"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHIBATA",
"first_name": "KENNETH",
"middle_name": "H",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-10",
"last_updated": "2014-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "WA",
"license": "MD00018056",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8243388",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "L & I",
"identifier": "0223687",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CRIME VICTIMS",
"identifier": "8933459",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD",
"identifier": "110248736",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "L & I",
"identifier": "167254",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tacoma, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.