1588112957 NPI number — EASTSIDE ORAL SURGERY ASSOCIATES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588112957 NPI number — EASTSIDE ORAL SURGERY ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EASTSIDE ORAL SURGERY ASSOCIATES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588112957
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1855 156TH AVE NE
Provider Second Line Business Mailing Address:
STE 101
Provider Business Mailing Address City Name:
BELLEVUE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98007-4386
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-641-5560
Provider Business Mailing Address Fax Number:
425-641-5563

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1855 156TH AVE NE
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98007-4386
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-641-5560
Provider Business Practice Location Address Fax Number:
425-641-5563
Provider Enumeration Date:
09/14/2016

Additional Information

Authorized Official

Authorized Official Last Name:
YU
Authorized Official First Name:
SEUNG
Authorized Official Middle Name:
Authorized Official Title or Position:
ORAL SURGEON
Authorized Official Telephone Number:
425-641-5560

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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