NPIMap

Individual provider Active NPI

John M Ukich, D.D.S.

  • Pediatric Dentistry
  • Coeur d'Alene, ID
National Provider Identifier
1902950041
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
D1626 Issued in ID
Practice address
1717 Lincoln Way
Suite 205
Coeur D Alene, ID 83814-2556
Phone
(208) 667-3556
Fax
(208) 664-6814
NPI assigned
Jan 23, 2007
Last updated
Jul 9, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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 D1626 ID Primary

Addresses

Primary practice location

1717 Lincoln Way
Suite 205
Coeur D Alene, ID 83814-2556

Mailing address

11493 N Eastshore Dr
Hayden Lake, ID 83835-9091
Phone (208) 667-3556

Other identifiers 4

IdentifierTypeStateIssuer
000010009296OtherIDBLUE SHIELD ID#
6G660OtherIDBLU CROSS ID#
526225OtherIDUNITED CONCORDIA #
D1656OtherIDSTATE LISENCE #

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
D1626IDMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
John M Ukich, DDS,PA Pediatric Dentistry Past Accepting new patients

Organizations & group practices 2

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": "1169510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1902950041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11493 N EASTSHORE DR",
            "city": "HAYDEN LAKE",
            "state": "ID",
            "postal_code": "838359091",
            "telephone_number": "208-667-3556",
            "fax_number": "208-664-6814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 LINCOLN WAY",
            "address_2": "SUITE 205",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142556",
            "telephone_number": "208-667-3556",
            "fax_number": "208-664-6814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UKICH",
        "first_name": "JOHN",
        "middle_name": "M",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-23",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "ID",
            "license": "D1626",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD ID#",
            "identifier": "000010009296",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLU CROSS ID#",
            "identifier": "6G660",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA #",
            "identifier": "526225",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LISENCE #",
            "identifier": "D1656",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Coeur d'Alene, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.