NPIMap

Individual provider Active NPI

Gennadiy Kalvish, D.D.S.

  • General Practice Dentistry
  • Lynnwood, WA
National Provider Identifier
1972986313
Registry record updated Jul 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DE60572275 Issued in WA
Practice address
1418 164TH St SW
Suite 100
Lynnwood, WA 98087-8500
Phone
(425) 742-8828
NPI assigned
Jul 2, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DE60572275 WA Primary

Addresses

Primary practice location

1418 164TH St SW
Suite 100
Lynnwood, WA 98087-8500

Mailing address

16027 SE 180TH PL
Renton, WA 98058-9176
Phone (253) 632-8963

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
DE60572275WAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Gennadiy Kalvish DDS PLLC General Practice Current Accepting new patients
Ekapoj Thongin, DMD, PLLC General Practice 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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1435795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435795200000",
    "number": "1972986313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16027 SE 180TH PL",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980589176",
            "telephone_number": "253-632-8963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1418 164TH ST SW",
            "address_2": "SUITE 100",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980878500",
            "telephone_number": "425-742-8828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KALVISH",
        "first_name": "GENNADIY",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-07-02",
        "last_updated": "2015-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE60572275",
            "primary": true
        }
    ],
    "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 Jul 2, 2015; 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.