Healthcare Provider Details

I. General information

NPI: 1699068106
Provider Name (Legal Business Name): JAKE MICHAEL BURNBAUM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2011
Last Update Date: 10/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 MLK JR. WAY SUITE 300
TACOMA WA
98405
US

IV. Provider business mailing address

2121 6TH AVE N1603
SEATTLE WA
98121-2933
US

V. Phone/Fax

Practice location:
  • Phone: 253-274-1668
  • Fax: 253-274-1685
Mailing address:
  • Phone: 310-490-3403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberBC60682237
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: