Healthcare Provider Details

I. General information

NPI: 1407973779
Provider Name (Legal Business Name): JESUS B. SY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2535 BEACON AVE S SUITE A
SEATTLE WA
98144-5125
US

IV. Provider business mailing address

2535 BEACON AVE S SUITE A
SEATTLE WA
98144-5125
US

V. Phone/Fax

Practice location:
  • Phone: 206-325-6036
  • Fax:
Mailing address:
  • Phone: 206-325-6036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberMD00022556
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: