MEDICARE: MR. JONATHAN G SHAM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	MD60292520	WA

General Provider Information

NPI Number	:	1194049171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JONATHAN G SHAM M.D.

Provider Business Mailing Address
First Line	:	1959 NE PACIFIC ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98195-6410
Country	:	US
Telephone Number	:	206-543-3687
Fax Number	:

Provider Business Practice Location Address
First Line	:	1959 NE PACIFIC ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98195-6410
Country	:	US
Telephone Number	:	206-543-3687
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2010
Last Update Date	:	09/10/2019

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