Unknown Individual – Nephrology Physician, NPI 1124065321

Unknown Individual is a healthcare provider. based in Tacoma, Washington. specializing in Nephrology Physician. They hold a License No. MD00028956 (WA). The NPI Number for Unknown Individual is 1124065321

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1124065321
Phone
(253) 272-5881
Address
1708 S YAKIMA AVE
Deactivation Date
6 May 2022
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 1708, South Yakima Avenue, McCarver Neighborhood, Tacoma, Pierce County, Washington, 98405, United States

    SUITE 107

    TACOMA, WA 98405

    Phone: (253) 272-5881

    Fax: (253) 383-0161

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 98405)

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Reviews

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Frequently asked questions

How is Unknown Individual identified in CMS data?
CMS-hosted NPPES data lists Unknown Individual with NPI 1124065321.
Is Unknown Individual's NPI deactivated?
The extract indicates Unknown Individual is not in an active NPI state.
What is Unknown Individual's primary classification?
Nephrology Physician is the headline specialty for Unknown Individual here. Clinical services aligned with this taxonomy classification.
What area does Unknown Individual serve?
Unknown Individual's listing highlights Tacoma, Washington; more addresses can appear in NPPES.
Is the information about Unknown Individual up to date?
Data updates when providers file changes in NPPES — treat critical facts as "verify if unsure."

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