Siva Prakash Kolla, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE60606397 Issued in WA

Practice address

16657 Northup Way
Bellevue, WA 98008-3045

Phone

(724) 393-2069

NPI assigned

May 12, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1210550400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689552000000",
    "number": "1932376779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8316 W BURROUGHS RD",
            "city": "DEER PARK",
            "state": "WA",
            "postal_code": "990069764",
            "telephone_number": "425-628-5353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16657 NORTHUP WAY",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980083045",
            "telephone_number": "724-393-2069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLLA",
        "first_name": "SIVA",
        "middle_name": "PRAKASH",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-05-12",
        "last_updated": "2023-07-17",
        "certification_date": "2023-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE60606397",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Youngjoo Koh, D.C
• Melanie Camille Kohler
• Nitika Kohli, LMP
• Brittany Kolesar, CO
• Shweta Kolhatkar
• Noah Kollegger
• Mary Kolpacoff, PH.D.
• Nancy Kolton, RPH
• Ann M Kolwitz, MD
• Gregory A Komenda, M.D.

• General Practice Dentistry in Bellevue, WA
• Providers in Bellevue, 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 Jul 17, 2023; 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.