Summit Dermatology PS

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

MD00042827 Issued in WA

Legal business name

SUMMIT DERMATOLOGY PS

Practice address

300 Lilly Rd NE
Unit a
Olympia, WA 98506-5428

Phone

(360) 754-4352

NPI assigned

Mar 22, 2016

Last updated

Mar 22, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jessica Kim, MD

Title

Owner/President

Phone

(360) 754-4352

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1458604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458604800000",
    "number": "1639531445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 LILLY RD NE",
            "address_2": "UNIT A",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 LILLY RD NE",
            "address_2": "UNIT A",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065428",
            "telephone_number": "360-754-4352"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMIT DERMATOLOGY PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-22",
        "last_updated": "2016-03-22",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "360-754-4352",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "WA",
            "license": "MD00042827",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Timothy W Sullivan
• Vicki B Sullivan, OTR/L, CHT
• Wendy Sullivan, LMP
• Sanghamitra Suman
• Theresa C Summer, LPC, NCC
• Eric Sun, DDS
• Suzanne Sheryl Sund, LMP
• Donald Andrew Sunde, D.M.D
• Ann-Kristin Sundell, M.D.
• Suneet S Bath D M D P S (Impressions Dentistry)

• Dermatology Physician in Olympia, WA
• Providers in Olympia, WA by specialty
• Dermatology Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.