NPIMap

Organization Active NPI

Dimitri Kuznetsov, M.D. PLLC

  • Pediatric Urology Physician
  • Port Townsend, WA
National Provider Identifier
1710184494
Registry record updated Nov 28, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Urology PhysicianTaxonomy code 2088P0231X
Legal business name
DIMITRI KUZNETSOV, M.D. PLLC
Practice address
1274 7TH St Ste B
Port Townsend, WA 98368-2404
Phone
(360) 385-2905
NPI assigned
Jun 27, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2007

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

Authorized official

Name
Mary E. Keyes
Title
Clinic Manager
Phone
(360) 385-2905

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Urology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2088P0231X Primary

Addresses

Primary practice location

1274 7TH St Ste B
Port Townsend, WA 98368-2404

Mailing address

1274 7TH St Ste B
Port Townsend, WA 98368-2404
Phone (360) 385-2905

Other identifiers 1

IdentifierTypeStateIssuer
1120955MedicaidWA

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1182902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196208000000",
    "number": "1710184494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1274 7TH ST STE B",
            "city": "PORT TOWNSEND",
            "state": "WA",
            "postal_code": "983682404",
            "telephone_number": "360-385-2905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1274 7TH ST STE B",
            "city": "PORT TOWNSEND",
            "state": "WA",
            "postal_code": "983682404",
            "telephone_number": "360-385-2905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIMITRI KUZNETSOV, M.D. PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-27",
        "last_updated": "2007-11-28",
        "status": "A",
        "authorized_official_last_name": "KEYES",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "CLINIC MANAGER",
        "authorized_official_telephone_number": "360-385-2905"
    },
    "taxonomies": [
        {
            "code": "2088P0231X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology, Pediatric Urology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1120955",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Townsend, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2007; 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.