1588642003 NPI number — K. DAVID EPLEY M.D.

Table of content: K. DAVID EPLEY M.D. (NPI 1588642003)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588642003 NPI number — K. DAVID EPLEY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EPLEY
Provider First Name:
K.
Provider Middle Name:
DAVID
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EPLEY
Provider Other First Name:
KENNETH
Provider Other Middle Name:
DAVID
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1588642003
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11800 NE 128TH ST
Provider Second Line Business Mailing Address:
SUITE 430
Provider Business Mailing Address City Name:
KIRKLAND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98034-7208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-823-3937
Provider Business Mailing Address Fax Number:
425-823-7479

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11800 NE 128TH ST
Provider Second Line Business Practice Location Address:
SUITE 430
Provider Business Practice Location Address City Name:
KIRKLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98034-7208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-823-3937
Provider Business Practice Location Address Fax Number:
425-823-7479
Provider Enumeration Date:
01/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  MD00036319 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207WX0110X , with the licence number: MD00036319 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 180033374 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: EP4302 . This is a "REGENCE HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8228090 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0122940 . This is a "LABOR & INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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