Provider Demographics
NPI:1679987457
Name:MOU, JONATHAN Y (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:Y
Last Name:MOU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11800 NE 128TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-7211
Mailing Address - Country:US
Mailing Address - Phone:425-814-5100
Mailing Address - Fax:425-814-5103
Practice Address - Street 1:11800 NE 128TH ST STE 300
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-7211
Practice Address - Country:US
Practice Address - Phone:425-814-5100
Practice Address - Fax:425-814-5103
Is Sole Proprietor?:No
Enumeration Date:2014-06-19
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS94-08450207Q00000X
ORMD185613207Q00000X
WAMD61378145207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine