Provider Demographics
NPI:1447614235
Name:JONG, KATHERINE ALEXIS (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:ALEXIS
Last Name:JONG
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 1:685 SPRING ST # 222
Mailing Address - Street 2:
Mailing Address - City:FRIDAY HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98250-8058
Mailing Address - Country:US
Mailing Address - Phone:206-486-6467
Mailing Address - Fax:917-900-1571
Practice Address - Street 1:136 ISLAND VIEW PL # 423
Practice Address - Street 2:
Practice Address - City:LOPEZ ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98261-8732
Practice Address - Country:US
Practice Address - Phone:917-447-8264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-08
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-PHYS-LIC-882962084P0800X
WAMD608724192084P0800X
WA60659381390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry