Provider Demographics
NPI:1245856830
Name:TOH, JACKIE C (MD)
Entity type:Individual
Prefix:DR
First Name:JACKIE
Middle Name:C
Last Name:TOH
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 1:13684 18TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-1047
Mailing Address - Country:US
Mailing Address - Phone:206-549-7269
Mailing Address - Fax:
Practice Address - Street 1:13684 18TH AVE SW
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-1047
Practice Address - Country:US
Practice Address - Phone:206-549-7269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00018283207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine