Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | MD00039764 | WA |
Y | 207R00000X | Internist | MD00039764 | WA |
Y | 111NI0900X | Internist | MD00039764 | WA |
NPI | 1770502841 |
---|---|
Provider Name | Dr. Seyed A Hejazi |
First Address | Mount Vernon, WA 98274-4127 |
Second Address | Arlington, WA 98223 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 09/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8275182 | (05) | WA |
G99912 | (02) | WA |