NPIMap

Individual provider Active NPI

Kathie H Wang, DDS, MSD

  • Pediatric Dentistry
  • Kent, WA
National Provider Identifier
1649776766
Registry record updated Jan 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
DE61039236 Issued in WA
Practice address
13034 SE Kent Kangley Rd
Kent, WA 98030-7965
Phone
(253) 631-6398
NPI assigned
Apr 5, 2018
Last updated
Jan 17, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 17, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X DE61039236 WA Primary

Addresses

Primary practice location

13034 SE Kent Kangley Rd
Kent, WA 98030-7965

Mailing address

13034 SE Kent Kangley Rd
Kent, WA 98030-7965
Phone (253) 631-6398

Other practice location 1

710 NW Juniper St Ste 208
Issaquah, WA 98027-2717
Phone (425) 837-0021

Other practice location 2

26812 Maple Valley Black Diamond Rd SE
Maple Valley, WA 98038-8309
Phone (425) 432-2200

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
DE61039236WAMDPediatric Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
Dawn Woo-Huysing, DMD, MSD, PLLC Pediatric Dentistry Past Accepting new patients
Nicholas Raklios, DDS, PLLC PastSince Jun 1, 2021 Accepting new patients
Nicholas Raklios, DDS, PLLC Pediatric Dentistry Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1522886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642377600000",
    "number": "1649776766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13034 SE KENT KANGLEY RD",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980307965",
            "telephone_number": "253-631-6398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13034 SE KENT KANGLEY RD",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980307965",
            "telephone_number": "253-631-6398"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "710 NW Juniper St Ste 208",
            "address_purpose": "LOCATION",
            "city": "Issaquah",
            "state": "WA",
            "postal_code": "980272717",
            "country_code": "US",
            "telephone_number": "425-837-0021",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "26812 Maple Valley Black Diamond Rd SE",
            "address_purpose": "LOCATION",
            "city": "Maple Valley",
            "state": "WA",
            "postal_code": "980388309",
            "country_code": "US",
            "telephone_number": "425-432-2200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WANG",
        "first_name": "KATHIE",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "credential": "DDS, MSD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-04-05",
        "last_updated": "2022-01-17",
        "certification_date": "2022-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "WA",
            "license": "DE61039236",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kent, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2022; 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.