Active NPI
John M Kisala, M.D.
- Surgery Physician
- Yakima, WA
National Provider Identifier
1629099759
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- MD00044226
- Practice address
- 3003 Tieton Dr
Suite 300
Yakima, WA 98902-3679 - Phone
- (509) 575-3946
- Fax
- (509) 225-6449
- NPI assigned
- Jul 22, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | MD00044226 | WA | Primary |
Addresses
Primary practice location
3003 Tieton Dr
Suite 300
Yakima, WA 98902-3679
Mailing address
PO Box 2947
Yakima, WA 98907-2947
Phone (509) 248-7849
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)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153526400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1199232000000",
"number": "1629099759",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2947",
"city": "YAKIMA",
"state": "WA",
"postal_code": "989072947",
"telephone_number": "509-248-7849",
"fax_number": "509-248-8291"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3003 TIETON DR",
"address_2": "SUITE 300",
"city": "YAKIMA",
"state": "WA",
"postal_code": "989023679",
"telephone_number": "509-575-3946",
"fax_number": "509-225-6449"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KISALA",
"first_name": "JOHN",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-22",
"last_updated": "2008-01-02",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "WA",
"license": "MD00044226",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Yakima, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.