Healthcare Provider Details

I. General information

NPI: 1992026561
Provider Name (Legal Business Name): MAHYAR BADREI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2010
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17181 REDMOND WAY STE 300
REDMOND WA
98052-4441
US

IV. Provider business mailing address

1035 116TH AVE NE
BELLEVUE WA
98004-4604
US

V. Phone/Fax

Practice location:
  • Phone: 425-635-6430
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberOP61156104
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberP4846
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: