Provider Demographics
NPI:1568690345
Name:CHAKRABORTY, JEAN E (MD)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:E
Last Name:CHAKRABORTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:ELIZABETH
Other - Last Name:HUFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1231 116TH AVE NE STE 950
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3832
Mailing Address - Country:US
Mailing Address - Phone:425-454-3366
Mailing Address - Fax:425-646-5198
Practice Address - Street 1:1231 116TH AVE NE STE 950
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3832
Practice Address - Country:US
Practice Address - Phone:425-454-3366
Practice Address - Fax:425-646-5198
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60394734207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2031052Medicaid