Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | DE61104841 | WA |
NPI | 1134722705 |
---|---|
Provider Name | Shervin Hashemzadeh |
First Address | Seattle, WA 98121-2016 |
Second Address | Seattle, WA 98121-2016 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2020 |
Last Update Date | 17/11/2020 |