Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | MD60849336 | WA |
NPI | 1124218722 |
---|---|
Provider Name | Jane Namkung |
First Address | Vancouver, WA 98685-2628 |
Second Address | Vancouver, WA 98685 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2007 |
Last Update Date | 04/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RES000 | (02) | CA |