Stephanie Kang, D.M.D

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE60550491 Issued in WA

Practice address

21005 44TH Ave W Ste 103
Mountlake Terrace, WA 98043-3584

Phone

(617) 997-8520

NPI assigned

Nov 19, 2012

Last updated

Aug 8, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: skang289249@direct.ochin.org

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.

• Stephanie Kang, DMD, PLLC

  • Dental Clinic/Center
  • Mountlake Terrace, WA
  • NPI 1154022317
  NPD Authorized official
• Seattle Roots Community Health

  dba Dental Clinic

  • Federally Qualified Health Center (FQHC)
  • Seattle, WA
  • NPI 1952883993
  NPD (past)

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

{
    "created_epoch": "1353283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691452800000",
    "number": "1548504277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21005 44TH AVE W STE 103",
            "city": "MOUNTLAKE TERRACE",
            "state": "WA",
            "postal_code": "980433584",
            "telephone_number": "425-616-2331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21005 44TH AVE W STE 103",
            "city": "MOUNTLAKE TERRACE",
            "state": "WA",
            "postal_code": "980433584",
            "telephone_number": "617-997-8520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANG",
        "first_name": "STEPHANIE",
        "credential": "D.M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-11-19",
        "last_updated": "2023-08-08",
        "certification_date": "2023-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223D0001X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Public Health",
            "state": "WA",
            "license": "DE60550491",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE60550491",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maudashley Joseph
• JSB Entertainment Inc. (Phoenix Dental Lab)
• Eduardo Jubis, D.C.
• Caitlin Anne Kahn, DPT
• Diane M Kalvelage, ARNP
• Kathryn L Jagow, DDS
• Sharla Ann Keeling, RPH
• Keith K Ly, DO, P.S.
• Danielle Kelley
• Matthew Patrick Kelley, DDS

• General Practice Dentistry in Mountlake Terrace, WA
• Providers in Mountlake Terrace, 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 Aug 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.