Jahja Djajaputra, LMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MA61098412 Issued in WA

Practice address

9633 Market PL Unit 103
Lake Stevens, WA 98258-7944

Phone

(425) 335-0300

Fax

(425) 335-0302

NPI assigned

Oct 5, 2020

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Market Place Chiropractic Wellness Center

  • Chiropractor
  • Lake Stevens, WA
  • NPI 1013160191
  NPD
• Walsh Chiropractic PLLC

  • Rehabilitation Chiropractor
  • Lake Stevens, WA
  • NPI 1497479893
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1601856000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601856000000",
    "number": "1649877481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11030 EVERGREEN WAY APT E123",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982046655",
            "telephone_number": "206-412-6179"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9633 MARKET PL UNIT 103",
            "city": "LAKE STEVENS",
            "state": "WA",
            "postal_code": "982587944",
            "telephone_number": "425-335-0300",
            "fax_number": "425-335-0302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DJAJAPUTRA",
        "first_name": "JAHJA",
        "name_prefix": "Mr.",
        "credential": "LMT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-10-05",
        "last_updated": "2020-10-05",
        "certification_date": "2020-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "WA",
            "license": "MA61098412",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LMT",
            "identifier": "MA61098412",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dental Professionals of Washington Quirt Mongrain Gibree PC
• Tina Michelle Dickson
• Shawn Dirksen
• Discover Healing
• Sarah J Dixen, MASSAGE THERAPIST
• Dkeidek, Fernyhough, Gile, Hagel, Nov & Quickstad PLLC
• Diana Doganiero Diaz
• Holly Jo Dorning, BA
• Lillian R Douds, MS - CCC-SLP
• Douglas J Brajcich Jr & Julie Lum DMD P.C.

• Massage Therapist in Lake Stevens, WA
• Providers in Lake Stevens, WA by specialty
• Massage Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.