Basic Information
| Provider Information | |||||||||
| NPI: | 1417336058 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | JAIN | ||||||||
| FirstName: | ANNA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22005 4TH AVE W | ||||||||
| Address2: | |||||||||
| City: | BOTHELL | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980215116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486796949 | ||||||||
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| Practice Location | |||||||||
| Address1: | 16233 SYLVESTER RD SW STE 230 | ||||||||
| Address2: | |||||||||
| City: | BURIEN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981663044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062427822 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2015 | ||||||||
| LastUpdateDate: | 10/27/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 4301107560 | MI | N | Allopathic & Osteopathic Physicians | Pediatrics | 390200000X | 4301107560 | MI | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208000000X | MD61123262 | WA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.