Trevor Dylan Kanack, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE60839553 Issued in WA

Practice address

220 Broadway E
Seattle, WA 98102-5724

Phone

(206) 686-3828

NPI assigned

Jul 11, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Ekapoj Thongin II, DMD, PLLC

  • Dental Clinic/Center
  • Seattle, WA
  • NPI 1750703658
  NPD (past)

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

{
    "created_epoch": "1499731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521417600000",
    "number": "1649792706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 BLANCHARD ST UNIT 1501",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981212656",
            "telephone_number": "469-369-6671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 BROADWAY E",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981025724",
            "telephone_number": "206-686-3828"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3302 Gaston Ave",
            "address_purpose": "LOCATION",
            "city": "Dallas",
            "state": "TX",
            "postal_code": "752462013",
            "country_code": "US",
            "telephone_number": "214-828-8140",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KANACK",
        "first_name": "TREVOR",
        "middle_name": "DYLAN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-07-11",
        "last_updated": "2018-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "33233",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE60839553",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeremy Kampp, M.D.
• Shawn E Kamps, MD
• Saima Kamran, MD
• Hope Mazzi Kamuwanda, LPN
• Diboro Kanabolo, MD
• John K Kanai, MBA, AAC
• Shelby Ann Kanaly, LMHC, CDPT
• Mohammed Mushtak Kanani, MD
• Kelly Jeanne Kanary, CRNA
• Naoya Kanazawa

• General Practice Dentistry in Seattle, WA
• Providers in Seattle, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2018; 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.