NPIMap

Individual provider Active NPI

Yuriy Vladimirovich Bagdasarov, DDS

  • Dentist
  • Everett, WA
National Provider Identifier
1609935857
Registry record updated May 1, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DE00008641 Issued in WA
Practice address
909 SE Everett Mall Way
B 250
Everett, WA 98208-3746
Phone
(425) 355-0600
Fax
(425) 348-4297
NPI assigned
Dec 6, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 1, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DE00008641 WA Primary

Addresses

Primary practice location

909 SE Everett Mall Way
B 250
Everett, WA 98208-3746

Mailing address

909 SE Everett Mall Way
B 250
Everett, WA 98208-3746
Phone (425) 355-0600

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

LicenseStateTypeSpecialty
DE00008641WAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Hojoong Ryu DDS PLLC Past Accepting new patients
Family Group Dental Inc 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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1367366400000",
    "number": "1609935857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "909 SE EVERETT MALL WAY",
            "address_2": "B 250",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982083746",
            "telephone_number": "425-355-0600",
            "fax_number": "425-348-4297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 SE EVERETT MALL WAY",
            "address_2": "B 250",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982083746",
            "telephone_number": "425-355-0600",
            "fax_number": "425-348-4297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAGDASAROV",
        "first_name": "YURIY",
        "middle_name": "VLADIMIROVICH",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-06",
        "last_updated": "2013-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE00008641",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Everett, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2013; 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.