MEDICARE: AYESAN HEMATI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0700X	Prosthodontics	0401417144	VA

General Provider Information

NPI Number	:	1689100315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AYESAN HEMATI

Provider Business Mailing Address
First Line	:	105 N VIRGINIA AVE
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22046-3339
Country	:	US
Telephone Number	:	703-533-7285
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 N VIRGINIA AVE STE 103
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22046-3323
Country	:	US
Telephone Number	:	703-533-7285
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2017
Last Update Date	:	02/12/2024

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