Provider Demographics
NPI:1629357744
Name:JIA, JIHUA (MD)
Entity type:Individual
Prefix:DR
First Name:JIHUA
Middle Name:
Last Name:JIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9240 SE SHORELAND DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-6519
Mailing Address - Country:US
Mailing Address - Phone:425-531-9887
Mailing Address - Fax:
Practice Address - Street 1:1417 116TH AVE NE STE 204
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3830
Practice Address - Country:US
Practice Address - Phone:425-298-7771
Practice Address - Fax:425-295-4285
Is Sole Proprietor?:No
Enumeration Date:2011-08-07
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60425608207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2036927Medicaid