Northwest Vein and Aesthetic Center PS

Primary specialty

Legal MedicineTaxonomy code 173000000X

License

MD00028685 Issued in WA

Legal business name

NORTHWEST VEIN AND AESTHETIC CENTER PS

Practice address

4700 Point Fosdick Dr NW Ste 307
Gig Harbor, WA 98335-1706

Phone

(253) 857-8346

Fax

(253) 857-0259

NPI assigned

Feb 18, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Aksel G Nordestgaard, MD

Title

President

Phone

(253) 857-8346

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Yi Soo Robert Kim, M.D.

  • Vascular Surgery Physician
  • Gig Harbor, WA
  • NPI 1891978128
  Medicare reassignment Care Compare group NPD
• Kylie Noel Pollard, PHYSICIAN ASSISTANT

  • Physician Assistant
  • Gig Harbor, WA
  • NPI 1386312189
  Medicare reassignment Care Compare group
• Kathryn L Zahour, ARNP

  • Nurse Practitioner
  • Gig Harbor, WA
  • NPI 1972831741
  Medicare reassignment NPD

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

{
    "created_epoch": "1234915200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1234915200000",
    "number": "1548409337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 POINT FOSDICK DR NW STE 307",
            "city": "GIG HARBOR",
            "state": "WA",
            "postal_code": "983351706",
            "telephone_number": "253-857-8346",
            "fax_number": "253-857-0259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 POINT FOSDICK DR NW STE 307",
            "city": "GIG HARBOR",
            "state": "WA",
            "postal_code": "983351706",
            "telephone_number": "253-857-8346",
            "fax_number": "253-857-0259"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST VEIN AND AESTHETIC CENTER PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-18",
        "last_updated": "2009-02-18",
        "status": "A",
        "authorized_official_last_name": "NORDESTGAARD",
        "authorized_official_first_name": "AKSEL",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "253-857-8346",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "173000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Legal Medicine",
            "state": "WA",
            "license": "MD00028685",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1083630602",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1067198",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Northland Hearing Centers, Inc.
• Northwest Center for Sports Medicine & Physical Therapy, Inc.
• Northwest Medical Specialist
• Northwest Psychological Services, Inc.
• Northwest Vein & Aesthetic Center
• Lily Sierra Novak, AUD
• Novel Healthcare, PLLC
• Michael Nicholas Nunn, PN
• Jocelyn Elise Nussbaum
• NW Iom LLC

• Legal Medicine in Gig Harbor, WA
• Providers in Gig Harbor, WA by specialty
• Legal Medicine in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.