Active NPI
Maryam Keikhosro-Kiani, DMD
- Dentist
- Kent, WA
National Provider Identifier
1992473862
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DE61204490
- Practice address
- 10725 SE 256TH St Ste 1
Kent, WA 98030-8285 - Phone
- (602) 551-5626
- NPI assigned
- Sep 3, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DE61204490 | WA | Primary |
Addresses
Primary practice location
10725 SE 256TH St Ste 1
Kent, WA 98030-8285
Mailing address
1415 Pipeline Road
Coquitlam, BRITISH COLUMBIA V3E 2X1
CA
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
| License | State | Type | Specialty |
|---|---|---|---|
| DE61204490 | WA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1630627200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1630627200000",
"number": "1992473862",
"addresses": [
{
"country_code": "CA",
"country_name": "Canada",
"address_purpose": "MAILING",
"address_type": "FGN",
"address_1": "1415 PIPELINE ROAD",
"city": "COQUITLAM",
"state": "BRITISH COLUMBIA",
"postal_code": "V3E 2X1"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10725 SE 256TH ST STE 1",
"city": "KENT",
"state": "WA",
"postal_code": "980308285",
"telephone_number": "602-551-5626"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KEIKHOSRO-KIANI",
"first_name": "MARYAM",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-09-03",
"last_updated": "2021-09-03",
"certification_date": "2021-09-03",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WA",
"license": "DE61204490",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kent, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.