Provider Demographics
NPI:1003989179
Name:FAHMY, JANA LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:JANA
Middle Name:LYNN
Last Name:FAHMY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1535
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98401-1535
Mailing Address - Country:US
Mailing Address - Phone:253-761-4200
Mailing Address - Fax:253-383-3553
Practice Address - Street 1:1304 FAWCETT AVE STE 100
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402
Practice Address - Country:US
Practice Address - Phone:253-761-4200
Practice Address - Fax:253-761-4201
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA000385762085U0001X
WAMD000385762085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0139020OtherLNI TRA-MINW, PS KING COUNTY
WA1090576Medicaid
WA0139021OtherLNI UAOM
WA7252FAOtherREGENCE BLUE SHIELD UNION AVENUE OPEN
WA0139020OtherLNI TRA-MINW, PS REST OF WA
WA3231FAOtherREGENCE BLUE SHIELD TRA
WA8254112Medicaid
WA300111131OtherRR MEDICARE TRA
WA8254112Medicaid
WA300111132OtherRR MEDICARE UNION AVENUE OPEN
WA7252FAOtherREGENCE BLUE SHIELD UNION AVENUE OPEN
WAG8882923OtherPTAN-MIO1
WAG8882923OtherPTAN-MIO1
WA139021OtherLABOR AND INDUSTRIES/WC UNION AVENUE OPEN
WA8254112Medicaid
WA7252FAOtherREGENCE BLUE SHIELD UNION AVENUE OPEN