Active NPI
Bishoy Awad
- Dentist
- Lynnwood, WA
National Provider Identifier
1821626706
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 61602657
- Practice address
- 4111 194TH St SW
Lynnwood, WA 98036-4604 - Phone
- (530) 651-3199
- NPI assigned
- Mar 27, 2020
- Reactivated
- Dec 17, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 61602657 | WA | Primary |
| Dentist | 122300000X | 106702 | CA |
Addresses
Primary practice location
4111 194TH St SW
Lynnwood, WA 98036-4604
Mailing address
4111 194TH St SW
Lynnwood, WA 98036-4604
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250515000798 | WA | Order and Referring Only - Dentist | 5597283457 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 106702 | CA | MD | Dentist |
| 61602657 | WA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1585267200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1743552000000",
"number": "1821626706",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4111 194TH ST SW",
"city": "LYNNWOOD",
"state": "WA",
"postal_code": "980364604"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4111 194TH ST SW",
"city": "LYNNWOOD",
"state": "WA",
"postal_code": "980364604",
"telephone_number": "530-651-3199"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AWAD",
"first_name": "BISHOY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-03-27",
"last_updated": "2025-04-02",
"certification_date": "2025-04-02",
"deactivation_date": "2021-08-24",
"reactivation_date": "2021-12-17",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WA",
"license": "61602657",
"primary": true
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "106702",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lynnwood, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.