Kenneth J Russell

Primary specialty

Radiation Oncology PhysicianTaxonomy code 2085R0001X

License

MD00023196 Issued in WA

Practice address

Seattle Cancer Care Alliance
825 Eastlake Avenue East
Seattle, WA 98109

Phone

(206) 288-1012

NPI assigned

Oct 27, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1851477509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 50095",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981455095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "SEATTLE CANCER CARE ALLIANCE",
            "address_2": "825 EASTLAKE AVENUE EAST",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "98109",
            "telephone_number": "206-288-1012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "KENNETH",
        "middle_name": "J",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "WA",
            "license": "MD00023196",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1009968",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INTERNAL ID-MOTOR VEHICLE ID",
            "identifier": "7017",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Garrett Russell, M.D.
• Jeremy Joseph Russell
• Karen Elizabeth Russell, LICSW
• Kathryn Renee-Smith Russell, RN, BSN, ARNP, MSN
• Kelly Leonora Russell, LMFT, CDPT
• Mai T Russell, MD
• Maria Camille Russell, N.D.
• Mark Stephen Russell Jr., LPC
• Mathew Russell, LMT
• Naomi Lynn Russell, LMP CCT

• Radiation Oncology Physician in Seattle, WA
• Providers in Seattle, WA by specialty
• Radiation Oncology Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.