Healthcare Provider Details

I. General information

NPI: 1588235709
Provider Name (Legal Business Name): KOUROSH PARASTESH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2021
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16200 116TH AVE SE
RENTON WA
98058-5200
US

IV. Provider business mailing address

955 POWELL AVE SW
RENTON WA
98057-2908
US

V. Phone/Fax

Practice location:
  • Phone: 425-400-1899
  • Fax: 425-988-1248
Mailing address:
  • Phone: 425-277-1311
  • Fax: 425-277-1566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE70016665
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDENT.DE.70016665
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code171R00000X
TaxonomyInterpreter
License NumberMA4305
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: