Healthcare Provider Details

I. General information

NPI: 1437578051
Provider Name (Legal Business Name): NAVID DAVID MALAKOUTI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2014
Last Update Date: 01/29/2020
Certification Date: 01/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15906 MILL CREEK BLVD
MILL CREEK WA
98012-1797
US

IV. Provider business mailing address

2041 GEORGIA AVE NW STE 2107
WASHINGTON DC
20060-0001
US

V. Phone/Fax

Practice location:
  • Phone: 425-385-2009
  • Fax: 425-939-0807
Mailing address:
  • Phone: 202-865-6725
  • Fax: 202-865-1757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD60916736
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: