NORTH PACIFIC DERMATOLOGY SERVICES, LLC (NPI# 1790973436) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790973436 |
| Entity Type | Organization |
| Organization Name | NORTH PACIFIC DERMATOLOGY SERVICES, LLC |
| Other Organization Name | NORTH PACIFIC DERMATOLOGY, P.S. |
| Practice Address |
1412 Sw 43rd St Ste 205 Renton WA 98057-4803 |
| Practice Telephone | 4252640660 |
| Practice Fax Number | 4252640601 |
| Mailing Telephone | 4252640660 |
| Mailing Fax Number | 4252640601 |
| Enumeration Date | 2007-10-09 |
| Last Update Date | 2010-01-11 |
| Authorized Official Name | NICOLE P KAGEYAMA (PRESIDENT) |
| Authorized Official Telephone | 4252640660 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207ND0900X |
Dermatology Specialization: Dermatopathology |
MTS-4912 | WA | Allopathic & Osteopathic Physicians |
| N | 261QA1903X |
Clinic/Center Specialization: Ambulatory Surgical |
WA | Ambulatory Health Care Facilities | |
| Y | 207N00000X | Dermatology | MD00046078 | WA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | RAILROAD MEDICARE | DE5794 | 01 |
| Other Name | Type Code |
|---|---|
| North Pacific Dermatology, P.S. | Former Legal Business Name - Organization |
| Street Address |
1412 SW 43RD ST STE 205 |
| City | RENTON |
| State | WA |
| Zip Code | 98057-4803 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407858665 | Nicole Prevo Kageyama | Dermatology | 1412 Sw 43rd St Ste 205, Renton, WA 98057-4803 | 2005-06-01 |
| 1457669541 | Andrew Deak | Specialist | 1412 Sw 43rd St Ste 205, Renton, WA 98057-4803 | 2010-09-22 |
| 1477502870 | Gina M Fragione | Physician Assistant | 1412 Sw 43rd St Ste 205, Renton, WA 98057-4803 | 2006-05-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043856628 | Megan Ramaiya | Student in an Organized Health Care Education/Training Program | King Count Sexual Assault & Resource Center, 200 Mill Ave S # 10, Renton, WA 98057 | 2019-11-19 |
| 1063076255 | Breanne Michele Smiley | Specialist/Technologist | 737 Logan Ave N, Renton, WA 98057 | 2019-04-24 |
| 1093215063 | Laura Lewis | Physical Medicine & Rehabilitation | 1000 Oakesdale Ave Sw Ste 100, Renton, WA 98057 | 2018-02-16 |
| 1437676004 | Ralph William Papke Jr. | Counselor | Kaiser Permanente of Wa, 1200 Sw 27th St, Renton, WA 98057 | 2017-08-24 |
| 1487106456 | Serengeti Care Partners LLC | Community/Behavioral Health | 707 S- Grady Way, Suite 6008, Renton, WA 98057 | 2016-10-26 |
| 1548716152 | Phandinh Ngoc Nguyen | Naturopath | 330 Sw 43rd St,suite L, Renton, WA 98057 | 2016-09-01 |
| 1275905721 | Todd R Glass | Chiropractor | 1024 N 10th Pl #2306, Renton, WA 98057 | 2015-10-23 |
| 1134595341 | Have A Heart | Case Management | 151 Taylor Ave Nw, Renton, WA 98057 | 2015-08-12 |
| 1780087171 | Brianne N Lefferts | Physical Therapist | 300 Sw 7th Street, Renton, WA 98057 | 2014-09-30 |
| 1588089460 | Sound Association Western Washington LLC | Audiologist | 108 Factory Ave. N., Ste 2b, Renton, WA 98057 | 2014-02-28 |
| Find all providers in zip 98057 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700037769 | Erica K Linnell | Dermatology | 350 S 38th Ct, Suite 115, Renton, WA 98055-5777 | 2008-10-08 |
| 1417046491 | Craig K Fujisaki | Dermatology | 4509 Talbot Rd S Ste 200, Renton, WA 98055-6294 | 2006-10-11 |
| 1316056070 | Llewellyn Phillips II | Dermatology | 4509 Talbot Rd S, Suite 200, Renton, WA 98055-6294 | 2006-08-29 |
| 1407858665 | Nicole Prevo Kageyama | Dermatology | 1412 Sw 43rd St Ste 205, Renton, WA 98057-4803 | 2005-06-01 |
| 1902251457 | Jodie Lynn Sasaki | Dermatology | 660 Sw 39th St Ste 150, Renton, WA 98057-4912 | 2016-05-03 |
| 1710238449 | Llewellyn Phillips II M.d., Inc., P.s. | Dermatology | 4509 Talbot Rd S, Suite 200, Renton, WA 98055-6294 | 2012-09-20 |
| 1063740926 | Craig K. Fujisaki, M.d., Inc, P.s. | Dermatology | 4509 Talbot Rd S Ste 200, Renton, WA 98055-6294 | 2009-12-03 |
| 1104962331 | Southlake Clinic Inc., P.s. | Dermatology | 4011 Talbot Rd S, Suite 500, Renton, WA 98055-5773 | 2007-01-29 |
| 1861577223 | Ellendee Pepper | Dermatology | 660 Sw 39th St, Ste 150, Renton, WA 98057-4912 | 2006-10-26 |
| 1801971262 | Brian H Kumasaka | Dermatology | 660 Sw 39th St, Ste 150, Renton, WA 98057-4912 | 2006-10-26 |
| Find all providers in RENTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.