EASTSIDE DERMATOLOGY INC PS NPI 1649379231

NPI Information

  • NPI: 1649379231
  • Provider Name: EASTSIDE DERMATOLOGY INC PS
  • Classification: Dermatology - 207NP0225X
  • Specialization: Pediatric Dermatology
  • Entity Type: Organization
  • Address: 14030 NE 24TH ST
    SUITE 202
    BELLEVUE, WA
    ZIP 98007
  • Phone: (425) 454-1104

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NPI Details

EASTSIDE DERMATOLOGY INC PS is a pediatric dermatology dermatology in Bellevue, WA. The provider is a pediatric dermatologist has, through additional special training, developed expertise in the treatment of specific skin disease categories with emphasis on those diseases which predominate in infants, children and adolescents. EASTSIDE DERMATOLOGY INC PS NPI is 1649379231. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

14030 NE 24TH ST
SUITE 202
BELLEVUE, WA
ZIP 98007-724
Phone: (425) 454-1104
Fax: (425) 454-1290

The provider's authorized official is Melanie A Jennings .
The authorized official title is Office Manager and has the following contact phone number (425) 454-1104.

The enumeration date for this NPI number is 9/21/2006 and was last updated on 9/11/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207N00000XDermatologyNo
2207NS0135XDermatologyProcedural DermatologyNo
3207NP0225XDermatologyPediatric DermatologyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
17080237MEDICAIDWASHINGTON
2CN9262OTHERWASHINGTONRAILROAD MEDIACRE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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