Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | MD00044424 | WA |
N | 208000000X | Pediatrician | MD00044424 | WA |
Y | 2080P0201X | Pediatric Allergist | MD00044424 | WA |
NPI | 1053401661 |
---|---|
Provider Name | Atoosa Kourosh |
First Address | Seattle, WA 98103-7536 |
Second Address | Seattle, WA 98103-7536 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 25/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P01733874 | RR MEDICARE WVH (01) | WA |