Active NPI
Pediatric Health Care
- Health Maintenance Organization
- Puyallup, WA
National Provider Identifier
1992965750
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Health Maintenance Organization
- License
- 025209 MD00038984
- Legal business name
- PEDIATRIC HEALTH CARE
- Practice address
- 120 14TH Ave SE Ste a
Puyallup, WA 98372-3718 - Phone
- (253) 848-7660
- Fax
- (253) 841-1801
- NPI assigned
- Jun 13, 2008
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Mazen Dahan, M.D.
- Title
- Manger
- Phone
- (253) 848-7660
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Health Maintenance Organization | 302R00000X | 025209 MD00038984 | WA | Primary |
Addresses
Primary practice location
120 14TH Ave SE Ste a
Puyallup, WA 98372-3718
Mailing address
120 14TH Ave SE Ste a
Puyallup, WA 98372-3718
Phone (253) 848-7660
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1115435 | Medicaid | WA |
National Provider Directory
National Provider Directory- Tax ID family
- Pediatric Health Care
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Pediatric Nurse Practitioner
- Puyallup, WA
- NPI 1689116691
Practitioners & affiliated clinicians
Practitioners 3
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Pediatrics Physician
- Puyallup, WA
- NPI 1578671830
-
- Family Nurse Practitioner
- Puyallup, WA
- NPI 1639609159
-
- Pediatric Nurse Practitioner
- Baton Rouge, LA
- NPI 1649712548
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1213315200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1213315200000",
"number": "1992965750",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "120 14TH AVE SE STE A",
"city": "PUYALLUP",
"state": "WA",
"postal_code": "983723718",
"telephone_number": "253-848-7660",
"fax_number": "253-841-1801"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "120 14TH AVE SE STE A",
"city": "PUYALLUP",
"state": "WA",
"postal_code": "983723718",
"telephone_number": "253-848-7660",
"fax_number": "253-841-1801"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PEDIATRIC HEALTH CARE",
"organizational_subpart": "NO",
"enumeration_date": "2008-06-13",
"last_updated": "2008-06-13",
"status": "A",
"authorized_official_last_name": "DAHAN",
"authorized_official_first_name": "MAZEN",
"authorized_official_title_or_position": "MANGER",
"authorized_official_telephone_number": "253-848-7660",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "302R00000X",
"taxonomy_group": "",
"desc": "Health Maintenance Organization",
"state": "WA",
"license": "025209 MD00038984",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1115435",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Puyallup, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.