Individual provider Active NPI

Aaron Wellborn, D.M.D.

  • General Practice Dentistry
  • Issaquah, WA
National Provider Identifier
1619052255
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
10290 Issued in WA
Practice address
22526 SE 64TH PL Ste 110
Issaquah, WA 98027-5368
Phone
(425) 427-1850
Fax
(425) 427-1870
NPI assigned
Oct 25, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 10290 WA Primary

Addresses

Primary practice location

22526 SE 64TH PL Ste 110
Issaquah, WA 98027-5368

Mailing address

22526 SE 64TH PL Ste 110
Issaquah, WA 98027-5368
Phone (425) 427-1850

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
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

Enrollment IDStateProvider typePAC IDDetails
I20250326002124 UT Order and Referring Only - DentistPractitioner - Dentist 8325561715

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
10290WAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Hongying Pan DDS PHD PLLC Past Accepting new patients
Hongying Pan DDS PHD PLLC General Practice PastSince Jun 18, 2023 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": "1161734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1619052255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22526 SE 64TH PL STE 110",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980275368",
            "telephone_number": "425-427-1850",
            "fax_number": "425-427-1870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22526 SE 64TH PL STE 110",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980275368",
            "telephone_number": "425-427-1850",
            "fax_number": "425-427-1870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WELLBORN",
        "first_name": "AARON",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "10290",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Issaquah, WA

Sources for this page

Verify at the official NPI Registry.