1396815742 NPI number — DR. JAY A. YRI-HALEN D.C.

Table of content: DR. JAY A. YRI-HALEN D.C. (NPI 1396815742)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396815742 NPI number — DR. JAY A. YRI-HALEN D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YRI-HALEN
Provider First Name:
JAY
Provider Middle Name:
A.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HALEN
Provider Other First Name:
JAY
Provider Other Middle Name:
A.
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1396815742
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/21/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12951 NE BEL RED RD STE 120
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLEVUE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98005-2628
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-497-2107
Provider Business Mailing Address Fax Number:
425-455-2910

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12951 NE BEL RED RD STE 120
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98005-2628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-497-2107
Provider Business Practice Location Address Fax Number:
425-455-2910
Provider Enumeration Date:
11/09/2006

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: 111N00000X , with the licence number:  CH00001239 , 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: 910990339 . This is a "TAX ID #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0015379 . This is a "L&I PROVIDER #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 600222041 . This is a "UBI #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: CH00001239 . This is a "WA STATE LICENSE #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0181959 . This is a "L&I IME PROVIDER #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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