Healthcare Provider Details

I. General information

NPI: 1417904038
Provider Name (Legal Business Name): KHAJISTA QAZI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 N BROADWAY
EVERETT WA
98201-1409
US

IV. Provider business mailing address

930 N BROADWAY
EVERETT WA
98201-1409
US

V. Phone/Fax

Practice location:
  • Phone: 425-789-3789
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD00036965
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: