Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2082S0105X | Plastic Hand Surgeon | MD00047758 | WA |
Y | 2086S0122X | Plastic and Reconstructive Surgery | MD00047758 | WA |
NPI | 1801801659 |
---|---|
Provider Name | Dr. Khashayar Dehghan |
First Address | Tacoma, WA 98405-1952 |
Second Address | Tacoma, WA 98405-1952 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2006 |
Last Update Date | 22/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H04069 | (02) | IL |