Active NPI
Yakov Yezhevsky
- Specialist
- Bothell, WA
National Provider Identifier
1255705166
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 60079835
- Practice address
- 9505 NE 180TH St
Apt 201
Bothell, WA 98011-3367 - Phone
- (206) 227-7546
- NPI assigned
- Nov 17, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 60079835 | WA | Primary |
Addresses
Primary practice location
9505 NE 180TH St
Apt 201
Bothell, WA 98011-3367
Mailing address
9505 NE 180TH St
Apt 201
Bothell, WA 98011-3367
Phone (206) 227-7546
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 646584 | Other | WA | EVERGREEN CARE NETWORK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 60079835 | WA | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1447718400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1447718400000",
"number": "1255705166",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9505 NE 180TH ST",
"address_2": "APT 201",
"city": "BOTHELL",
"state": "WA",
"postal_code": "980113367",
"telephone_number": "206-227-7546"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9505 NE 180TH ST",
"address_2": "APT 201",
"city": "BOTHELL",
"state": "WA",
"postal_code": "980113367",
"telephone_number": "206-227-7546"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YEZHEVSKY",
"first_name": "YAKOV",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-11-17",
"last_updated": "2015-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "WA",
"license": "60079835",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EVERGREEN CARE NETWORK",
"identifier": "646584",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bothell, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.