Healthcare Provider Details

I. General information

NPI: 1538470927
Provider Name (Legal Business Name): HODA SAMIA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2010
Last Update Date: 07/17/2020
Certification Date: 07/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1909 214TH ST SE STE 110
BOTHELL WA
98021-4412
US

IV. Provider business mailing address

1909 214TH ST SE STE 110
BOTHELL WA
98021-4412
US

V. Phone/Fax

Practice location:
  • Phone: 425-488-4988
  • Fax:
Mailing address:
  • Phone: 425-488-4988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD61027280
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: