Organization
EASTSIDE RHEUMATOLOGY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENT T TA MD (PHYSICIAN/OWNER)
(206) 240-6423
Entity
Organization
Contact information
Practice address
1380 112TH AVE NE STE 202, BELLEVUE, WA 98004-3759
(425) 590-9521
(425) 590-9574
Mailing address
1380 112TH AVE NE STE 202, BELLEVUE, WA 98004-3759
(425) 590-9521
(425) 590-9574
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MD00040870
WA MEDICAL LICENSE
WA
Enumeration date
07/05/2023
Last updated
07/05/2023
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