LAKEWOOD SURGICAL UROLOGY PS (NPI# 1215023940) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215023940 |
| Entity Type | Organization |
| Organization Name | LAKEWOOD SURGICAL UROLOGY PS |
| Practice Address |
11306 Bridgeport Way Sw Suite D Lakewood WA 98499-3005 |
| Mailing Address |
Po Box 97115 Lakewood WA 98497-0115 |
| Practice Telephone | 2535817000 |
| Practice Fax Number | 2539846774 |
| Mailing Telephone | 2535887911 |
| Mailing Fax Number | 2539846774 |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. JOHN B BAK (OWNER/PROVIDER) |
| Authorized Official Telephone | 2535817000 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208800000X | Urology | MD00044997 | WA | Allopathic & Osteopathic Physicians |
| Street Address |
11306 BRIDGEPORT WAY SW SUITE D |
| City | LAKEWOOD |
| State | WA |
| Zip Code | 98499-3005 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124009303 | Kyong Ho Kim | Pain Medicine | 11306 Bridgeport Way Sw, Suite D, Lakewood, WA 98499-3037 | 2005-11-07 |
| 1013311679 | Paul Bradley | Physician Assistant | 11306 Bridgeport Way Sw, Ste D, Lakewood, WA 98499-3037 | 2014-10-10 |
| 1982855995 | Bridgeport Medical Clinic Pllc | Clinic/Center | 11306 Bridgeport Way Sw, Suite B, Lakewood, WA 98499-3037 | 2008-10-08 |
| 1053431684 | Sound Pain Alliance | Pain Medicine | 11306 Bridgeport Way Sw, #d, Lakewood, WA 98499-3037 | 2007-03-29 |
| 1669586087 | Dennis Jooyoung Kim | Internal Medicine | 11306 Bridgeport Way Sw, Suite B, Lakewood, WA 98499-3037 | 2006-08-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275159592 | Sea Mar Community Health Centers | Clinic/Center | 5700 100th Street Se, Suite 510, Lakewood, WA 98499 | 2020-06-23 |
| 1568018828 | Heather Leigh Andrade | Behavioral Analyst | 6210 75th St W Ste 100, Lakewood, WA 98499 | 2019-08-13 |
| 1043870876 | Seoul Chinese Herbs Inc | Acupuncturist | 8705 S. Tacoma Way, Lakewood, WA 98499 | 2019-06-14 |
| 1013572064 | Puget Sound Kidney Centers | Clinic/Center | 11950 47th Ave Sw, Lakewood, WA 98499 | 2019-05-06 |
| 1447736657 | Marcela Cunan | Counselor | 9330 59th Avenue Southest, Lakewood, WA 98499 | 2018-07-11 |
| 1609382381 | Leroy Moore IIi | Counselor | 8811 S. Tacoma Way, 106, Lakewood, WA 98499 | 2017-12-18 |
| 1578077657 | Andrea Gaston | Behavior Technician | 8815 S. Tacoma Way, Suite 122, Lakewood, WA 98499 | 2017-11-27 |
| 1609389931 | Jennifer King | Social Worker | 5900 100th St Sw Ste 17b, Lakewood, WA 98499 | 2017-11-08 |
| 1750806337 | Wonyoung Lee | Counselor | 8811 South Tacoma Way, Suite 106, Lakewood, WA 98499 | 2017-08-04 |
| 1043749443 | Frederick Paltron Edwards | Counselor | 9500 Front Street, Suite 100, Lakewood, WA 98499 | 2017-06-08 |
| Find all providers in zip 98499 | ||||
| Taxonomy Code | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164507356 | Nand S Datta | Urology | 5750 Downey Avenue, Suite #100, Lakewood, CA 90712 | 2006-10-26 |
| 1417976705 | Greater Long Beach Genito-urinary Med Grp | Urology | 3650 South Street, Suite 408, Lakewood, CA 90712-1510 | 2006-07-18 |
| 1679559603 | Lawrence Robert Vidrine | Urology | 11367 Bridgeport Way Sw, Suite 217, Lakewood, WA 98499-3004 | 2005-12-21 |
| 1144212598 | Kiritkumar M Pandya | Urology | 101 Prospect St, St#101, Lakewood, NJ 08701-5020 | 2005-08-20 |
| 1063413938 | John B Bak | Urology | 11307 Bridgeport Way Sw Ste 217, Lakewood, WA 98499-3024 | 2005-08-02 |
| 1003147869 | Franciscan Medical Group | Urology | 11307 Bridgeport Way Sw, Suite 217, Lakewood, WA 98499-3024 | 2010-01-19 |
| 1811162555 | William M Zurich Jr Md Imrt LLC | Urology | 900 Route 70 East, Lakewood, NJ 08701-5940 | 2008-04-24 |
| 1316959125 | Associated Urologists LLC | Urology | 1255 Highway 70, Suite 33s, Lakewood, NJ 08701-5900 | 2006-08-12 |
| 1437181286 | Franciscan Medical Group | Urology | 11307 Bridgeport Way Sw, Ste 217, Lakewood, WA 98499-3024 | 2006-07-06 |
| 1356370167 | Jay Winemiller | Urology | 11307 Bridgeport Way Sw, Ste 217, Lakewood, WA 98499-3024 | 2006-07-02 |
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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.