NPIMap

Organization Active NPI

Karbakhsch Periodontics & Implants - South PLLC

Doing business as MK Periodontics & Implants

  • Periodontics
  • Puyallup, WA
National Provider Identifier
1639458722
Registry record updated Aug 8, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
8579 Issued in WA
Legal business name
KARBAKHSCH PERIODONTICS & IMPLANTS - SOUTH PLLC
Doing business as
MK Periodontics & Implants
Practice address
819 39TH Ave SW Ste B
Puyallup, WA 98373-3306
Phone
(253) 752-6336
Fax
(253) 752-5655
NPI assigned
Aug 8, 2011
Last updated
Aug 8, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
KARBAKHSCH PERIODONTICS & IMPLANTSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 8, 2011

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

Authorized official

Name
Dr. Minou Karbakhsch, DDS, MSDNPI 1659492718
Title
Owner
Phone
(253) 752-6336

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
PeriodonticsGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0300X 8579 WA Primary

Addresses

Primary practice location

819 39TH Ave SW Ste B
Puyallup, WA 98373-3306

Mailing address

2302 S Union Ave Ste C22
Tacoma, WA 98405-1334
Phone (253) 752-6336

Other identifiers 1

IdentifierTypeStateIssuer
8579OtherWAWASHINGTON STATE DENTAL LICENSE

Other names 1

  • MK Periodontics & Implants Doing business as

National Provider Directory

National Provider Directory

Locations

2302 S Union Ave
Ste C22
Tacoma, WA 98405
Phone (253) 752-5655

Practitioners & affiliated clinicians

Practitioners 2

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": "1312761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1312761600000",
    "number": "1639458722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2302 S UNION AVE STE C22",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984051334",
            "telephone_number": "253-752-6336",
            "fax_number": "253-752-5655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "819 39TH AVE SW STE B",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983733306",
            "telephone_number": "253-752-6336",
            "fax_number": "253-752-5655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KARBAKHSCH PERIODONTICS & IMPLANTS - SOUTH PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KARBAKHSCH PERIODONTICS & IMPLANTS",
        "enumeration_date": "2011-08-08",
        "last_updated": "2011-08-08",
        "status": "A",
        "authorized_official_last_name": "KARBAKHSCH",
        "authorized_official_first_name": "MINOU",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "253-752-6336",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, MSD"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "WA",
            "license": "8579",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WASHINGTON STATE DENTAL LICENSE",
            "identifier": "8579",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MK Periodontics & Implants",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Puyallup, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2011; 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.