NPIMap

Organization Active NPI

Eastside OB/GYN PLLC

  • Obstetrics & Gynecology Physician
  • Kirkland, WA
National Provider Identifier
1740421585
Registry record updated Jul 17, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
MD00038545 Issued in WA
Legal business name
EASTSIDE OB/GYN PLLC
Practice address
12303 NE 130TH LN Ste 450
Kirkland, WA 98034-3032
Phone
(425) 899-5000
Fax
(425) 899-5006
NPI assigned
Mar 6, 2009
Last updated
Jul 17, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jean R Dydell, M.D.NPI 1043390982
Title
Owner
Phone
(425) 899-5000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X MD00038545 WA Primary

Addresses

Primary practice location

12303 NE 130TH LN Ste 450
Kirkland, WA 98034-3032

Mailing address

12303 NE 130TH LN Ste 450
Kirkland, WA 98034-3032
Phone (425) 899-5000

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/21009/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1236297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1374019200000",
    "number": "1740421585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12303 NE 130TH LN STE 450",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980343032",
            "telephone_number": "425-899-5000",
            "fax_number": "425-899-5006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12303 NE 130TH LN STE 450",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980343032",
            "telephone_number": "425-899-5000",
            "fax_number": "425-899-5006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTSIDE OB/GYN PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-06",
        "last_updated": "2013-07-17",
        "status": "A",
        "authorized_official_last_name": "DYDELL",
        "authorized_official_first_name": "JEAN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "425-899-5000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "WA",
            "license": "MD00038545",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kirkland, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.