Individual
MS. LEENA CHACKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
18100 NE UNION HILL RD STE 200, REDMOND, WA 98052-3330
(206) 320-5190
(206) 320-5191
Mailing address
PO BOX 25608, SALT LAKE CITY, UT 84125-0608
(206) 320-4476
(206) 568-7043
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD00047003
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1015192
—
WA
01
—
218598
LABOR & INDUSTRIES
WA
01
—
2288CH
BLUE SHIELD
WA
05
—
8475550
—
WA
Enumeration date
02/28/2007
Last updated
11/20/2024
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