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LIGHTHOUSE PEDIATRIC MEDICINE PLLC
NPI 1336967611
Pediatrics in Issaquah, WA

Active since September 26, 2024CLIA 50D2310267 · Waiver
1505 NW GILMAN BLVD STE 8, ISSAQUAH, WA 98027(425) 243-3599 Get Directions Write a Review

NPPES record last updated: September 26, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Lighthouse Pediatric Medicine Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LIGHTHOUSE PEDIATRIC MEDICINE PLLC (NPI 1336967611), doing business as Lighthouse Pediatrics, is a healthcare organization registered as a pediatrics in Issaquah, Washington and active in the NPI registry since September 2024. The organization holds a CLIA Waiver certificate valid through April 4, 2028 and lists Sung Park, Managing Member, Physician, Owner, as its authorized official.

NPPES Registry Identity

NPI1336967611
Entity TypeOrganization
Primary Taxonomy208000000X
Legal Business NameLIGHTHOUSE PEDIATRIC MEDICINE PLLC
Location Address1505 NW GILMAN BLVD STE 8Issaquah, WA 98027-5398
Mailing Address1505 Nw Gilman Blvd Ste 8Issaquah, WA 98027-5398 · (425) 243-3599
Phone(425) 243-3599
Organization SubpartNo
Authorized OfficialSung ParkManaging Member, Physician, Owner · (425) 243-3599
Enumeration DateSeptember 26, 2024
NPPES CertifiedSeptember 26, 2024
✔ NPI 1336967611 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
Definition
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
1505 NW GILMAN BLVD STE 8, Issaquah, WA 98027
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Other Names 1

Doing Business AsLighthouse Pediatrics

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 50D2310267

Lighthouse Pediatrics · Issaquah, WA
Active · expires Apr 4, 2028
CLIA Number50D2310267
Laboratory TypePhysician Office
Certificate Effective DateAugust 29, 2024
Certificate Expiration DateApril 4, 2028
Laboratory DirectorSung Park
Laboratory Phone(425) 243-3599
Laboratory LocationLighthouse Pediatrics1505 NW Gilman Blvd Ste 8, Issaquah, WA 98027
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. SUNG EUN PARK MD
Pediatrics
1505 NW GILMAN BLVD STE 8
ISSAQUAH, WA 98027
King County (425) 357-7082
DARLENE SUSAN GREEN LMP
Massage Therapist
1505 NW GILMAN BLVD STE 8
ISSAQUAH, WA 98027
King County (425) 313-9222
MARIA ZULEMA ANCIRA LMP
Massage Therapist
1505 NW GILMAN BLVD STE 8
ISSAQUAH, WA 98027
King County (425) 313-9222

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Lighthouse Pediatric Medicine PLLC's NPI number?

The NPI number for Lighthouse Pediatric Medicine PLLC is 1336967611. It was assigned to this organization in the NPPES registry on September 26, 2024. The provider is doing business as Lighthouse Pediatrics.

Where is Lighthouse Pediatric Medicine PLLC located?

Lighthouse Pediatric Medicine PLLC is located at 1505 NW Gilman Blvd Ste 8, Issaquah, WA 98027. The listed phone number is (425) 243-3599.

What is Lighthouse Pediatric Medicine PLLC's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Does Lighthouse Pediatric Medicine PLLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 50D2310267) is associated with this NPI, valid through April 4, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Lighthouse Pediatric Medicine PLLC was last updated on September 26, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 22 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.