Healthcare Provider Details

I. General information

NPI: 1346214558
Provider Name (Legal Business Name): SARAH I HOUSSAYNI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 02/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 N EMPORIA ST
WICHITA KS
67214-3707
US

IV. Provider business mailing address

PO BOX 1897
WICHITA KS
67201-1897
US

V. Phone/Fax

Practice location:
  • Phone: 316-858-3460
  • Fax: 316-858-3458
Mailing address:
  • Phone: 316-268-8131
  • Fax: 316-291-4788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number04-30264
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: