Provider Demographics
NPI:1417310350
Name:JEANLIONE, MAIKHA (MD)
Entity Type:Individual
Prefix:
First Name:MAIKHA
Middle Name:
Last Name:JEANLIONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MAIKHA
Other - Middle Name:
Other - Last Name:JEAN-BAPTISTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 5127
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-5127
Mailing Address - Country:US
Mailing Address - Phone:425-397-1704
Mailing Address - Fax:425-335-5145
Practice Address - Street 1:3915 TALBOT RD S STE 401
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5738
Practice Address - Country:US
Practice Address - Phone:425-690-3445
Practice Address - Fax:425-690-9445
Is Sole Proprietor?:No
Enumeration Date:2016-03-29
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WAMD61052759207Q00000X
CAA152726207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2166735Medicaid