Organization
EVERGREEN MEDICAL PANEL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JESSY E ANG M.D (PSYCHIATIES)
(253) 576-4171
Entity
Organization
Contact information
Practice address
2411 S 19TH ST, TACOMA, WA 98405-2954
(253) 572-4171
(253) 572-4291
Mailing address
2411 S 19TH ST, TACOMA, WA 98405-2954
(253) 572-4171
(253) 572-4291
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
0700013011
WA
Other
Enumeration date
10/10/2007
Last updated
10/11/2007
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