Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | MD61041303 | WA |
NPI | 1275945081 |
---|---|
Provider Name | Jessica Ogawa |
First Address | Tacoma, WA 98415 |
Second Address | Tacoma, WA 98405-3720 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2014 |
Last Update Date | 04/08/2020 |