Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 29412 | WA |
Y | 208800000X | Urologist | 29412 | WA |
NPI | 1841274412 |
---|---|
Provider Name | Karny Jacoby |
First Address | Mountlake Terrace, WA 98043 |
Second Address | Mountlake Terrace, WA 98043 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2005 |
Last Update Date | 30/05/2017 |