Healthcare Provider Details

I. General information

NPI: 1255484283
Provider Name (Legal Business Name): JASON WILLIAM BURNS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2007
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11511 NE 10TH ST
BELLEVUE WA
98004-8578
US

IV. Provider business mailing address

2801 ATLANTIC AVE
LONG BEACH CA
90806
US

V. Phone/Fax

Practice location:
  • Phone: 425-502-3000
  • Fax:
Mailing address:
  • Phone: 562-933-1550
  • Fax: 562-933-8088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License Number18439
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: