Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | MD00022556 | WA |
NPI | 1407973779 |
---|---|
Provider Name | Jesus B. Sy |
First Address | Seattle, WA 98144-5125 |
Second Address | Seattle, WA 98144-5125 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2007 |
Last Update Date | 08/07/2007 |