Healthcare Provider Details

I. General information

NPI: 1972072106
Provider Name (Legal Business Name): KATAYOUN AKBARI PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2018
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7315 212TH ST SW STE 101207
EDMONDS WA
98026-7610
US

IV. Provider business mailing address

PO BOX 741515
LOS ANGELES CA
90074-1515
US

V. Phone/Fax

Practice location:
  • Phone: 425-775-9474
  • Fax: 425-670-3554
Mailing address:
  • Phone: 425-775-9474
  • Fax: 425-670-3554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60916865
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: