NPIMap

Organization Active NPI

Pan-Pacific Dentistry, P.C.

Doing business as Pan-Pacific Dentistry

  • Dentist
  • Tukwila, WA
National Provider Identifier
1548686165
Registry record updated Mar 6, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DE00009638 Issued in WA
Legal business name
PAN-PACIFIC DENTISTRY, P.C.
Doing business as
Pan-Pacific Dentistry
Practice address
411 Strander Blvd
#207
Tukwila, WA 98188-2935
Phone
(206) 575-8180
Fax
(206) 575-8483
NPI assigned
Mar 6, 2014
Last updated
Mar 6, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2014

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

Authorized official

Name
Dr. Osamu Nakade, DDSNPI 1689758609
Title
Owner
Phone
(206) 575-8180

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X DE00009638 WA Primary

Addresses

Primary practice location

411 Strander Blvd
#207
Tukwila, WA 98188-2935

Mailing address

411 Strander Blvd
#207
Tukwila, WA 98188-2935
Phone (206) 575-8180

Other identifiers 1

IdentifierTypeStateIssuer
5048723MedicaidWA

Other names 1

  • PAN-PACIFIC DENTISTRY Doing business as

National Provider Directory

National Provider Directory

Locations

411 Strander Blvd
Ste 207
Tukwila, WA 98188
Phone (206) 575-8180

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1394064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1394064000000",
    "number": "1548686165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 STRANDER BLVD",
            "address_2": "#207",
            "city": "TUKWILA",
            "state": "WA",
            "postal_code": "981882935",
            "telephone_number": "206-575-8180",
            "fax_number": "206-575-8483"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 STRANDER BLVD",
            "address_2": "#207",
            "city": "TUKWILA",
            "state": "WA",
            "postal_code": "981882935",
            "telephone_number": "206-575-8180",
            "fax_number": "206-575-8483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAN-PACIFIC DENTISTRY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-06",
        "last_updated": "2014-03-06",
        "status": "A",
        "authorized_official_last_name": "NAKADE",
        "authorized_official_first_name": "OSAMU",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "206-575-8180",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE00009638",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5048723",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PAN-PACIFIC DENTISTRY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tukwila, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 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.

Verify at the official NPI Registry.