Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 0401416814 | VA |
NPI | 1053993295 |
---|---|
Provider Name | Farnaz Younessian |
First Address | Fairfax, VA 22030-8155 |
Second Address | Fairfax, VA 22033-2945 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2021 |
Last Update Date | 27/04/2021 |