Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | OP60758015 | WA |
NPI | 1124465901 |
---|---|
Provider Name | Jessica K Chan |
First Address | Vancouver, WA 98687-3010 |
Second Address | Vancouver, WA 98664-1913 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2013 |
Last Update Date | 29/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2063530 | (05) | WA |