Healthcare Provider Details

I. General information

NPI: 1699145607
Provider Name (Legal Business Name): SAFIA KASSAM JOHNSON N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SAFIA MOHAMED KASSAM N.D.

II. Dates (important events)

Enumeration Date: 10/02/2015
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 COLUMBIA STREET
NEW WESTMINSTER BC
V3M1B1
CA

IV. Provider business mailing address

21619 119TH CT SE
KENT WA
98031-3957
US

V. Phone/Fax

Practice location:
  • Phone: 604-544-7656
  • Fax:
Mailing address:
  • Phone: 206-888-1195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number60603258
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: