NPIMap

Organization Active NPI

Silverdale Pediatrics

  • Pediatrics Physician
  • Silverdale, WA
National Provider Identifier
1952433765
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
SILVERDALE PEDIATRICS
Practice address
9615 Levin Road
Suite 101
Silverdale, WA 98383
Phone
(360) 692-8588
Fax
(360) 692-7030
NPI assigned
Mar 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Niran S Al AgbaNPI 1609830553
Title
Physician Owner
Phone
(360) 692-8588

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

9615 Levin Road
Suite 101
Silverdale, WA 98383

Mailing address

9615 Levin Road
Suite 101
Silverdale, WA 98383
Phone (360) 692-8588

Other identifiers 1

IdentifierTypeStateIssuer
7113574MedicaidWA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1173398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1952433765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9615 LEVIN ROAD",
            "address_2": "SUITE 101",
            "city": "SILVERDALE",
            "state": "WA",
            "postal_code": "98383",
            "telephone_number": "360-692-8588",
            "fax_number": "360-692-7030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9615 LEVIN ROAD",
            "address_2": "SUITE 101",
            "city": "SILVERDALE",
            "state": "WA",
            "postal_code": "98383",
            "telephone_number": "360-692-8588",
            "fax_number": "360-692-7030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SILVERDALE PEDIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "AL AGBA",
        "authorized_official_first_name": "NIRAN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PHYSICIAN OWNER",
        "authorized_official_telephone_number": "360-692-8588",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7113574",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Silverdale, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.