Provider Demographics
NPI:1427252873
Name:EASTSIDE PSYCHIATRIC SERVICES INC PS
Entity type:Organization
Organization Name:EASTSIDE PSYCHIATRIC SERVICES INC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANG
Authorized Official - Middle Name:HO
Authorized Official - Last Name:SUH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-822-8153
Mailing Address - Street 1:2820 NORTHUP WAY STE 105
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-1419
Mailing Address - Country:US
Mailing Address - Phone:425-822-8153
Mailing Address - Fax:425-822-4010
Practice Address - Street 1:2820 NORTHUP WAY STE 105
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-1419
Practice Address - Country:US
Practice Address - Phone:425-822-8153
Practice Address - Fax:425-822-4010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000353832084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8855383Medicare PIN
WAG66017Medicare UPIN