Provider Demographics
NPI:1437129012
Name:KHAW, JAMIE S (MD)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:S
Last Name:KHAW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8614 E MILL PLAIN #201
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664
Mailing Address - Country:US
Mailing Address - Phone:360-254-9991
Mailing Address - Fax:360-254-9997
Practice Address - Street 1:8614 E MILL PLAIN #201
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664
Practice Address - Country:US
Practice Address - Phone:360-254-9991
Practice Address - Fax:360-254-9997
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00048511208600000X
PAMD427182208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1014143190001Medicaid
I43720Medicare UPIN
PA1014143190001Medicaid