Healthcare Provider Details

I. General information

NPI: 1588112957
Provider Name (Legal Business Name): EASTSIDE ORAL SURGERY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 156TH AVE NE STE 101
BELLEVUE WA
98007-4386
US

IV. Provider business mailing address

1855 156TH AVE NE STE 101
BELLEVUE WA
98007-4386
US

V. Phone/Fax

Practice location:
  • Phone: 425-641-5560
  • Fax: 425-641-5563
Mailing address:
  • Phone: 425-641-5560
  • Fax: 425-641-5563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. SEUNG YU
Title or Position: ORAL SURGEON
Credential: DDS
Phone: 425-641-5560