Provider Demographics
NPI:1659032985
Name:DEAR, YEDIDYA KOHELET (BSN, RN-BC, CPHT)
Entity Type:Individual
Prefix:MR
First Name:YEDIDYA
Middle Name:KOHELET
Last Name:DEAR
Suffix:
Gender:M
Credentials:BSN, RN-BC, CPHT
Other - Prefix:
Other - First Name:DIDDY
Other - Middle Name:
Other - Last Name:DEAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1 DALLAS AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-5904
Mailing Address - Country:US
Mailing Address - Phone:929-351-4888
Mailing Address - Fax:
Practice Address - Street 1:3500 GASTON AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2017
Practice Address - Country:US
Practice Address - Phone:929-351-4888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-08
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX292904183700000X
TX1065937163W00000X, 163WC0200X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No183700000XPharmacy Service ProvidersPharmacy Technician
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine