Individual
DR. SANDHYA JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1304 FAWCETT AVE STE 100, TACOMA, WA 98402-1900
(253) 761-4200
(253) 761-4201
Mailing address
PO BOX 1535, TACOMA, WA 98401-1535
(253) 761-4200
(253) 383-3553
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
MD60949842
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0422785
L&I-TRA-REST OF WA
WA
01
—
0422789
L&I-TRA-KING
WA
01
—
0422790
L&I-UNION AVENUE OPEN MRI
WA
01
—
0422792
L&I-DIAGNOSTIC IMAGING NW
WA
05
—
2133414
—
WA
Enumeration date
04/01/2014
Last updated
07/01/2020
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