Individual
MR. JESSY AWITEN ANG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2411 S 19TH ST, TACOMA, WA 98405-2954
(253) 627-6606
(253) 572-4291
Mailing address
2411 S 19TH ST, TACOMA, WA 98405-2954
(253) 627-6606
(253) 572-4291
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
18096
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1548908
—
WA
Enumeration date
05/07/2007
Last updated
07/08/2007
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