Healthcare Provider Details

I. General information

NPI: 1760392807
Provider Name (Legal Business Name): FERAS HANTASH PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1165 EASTLAKE AVE E
SEATTLE WA
98109-4456
US

IV. Provider business mailing address

25071 BELLOTA
MISSION VIEJO CA
92692-2705
US

V. Phone/Fax

Practice location:
  • Phone: 206-775-5754
  • Fax:
Mailing address:
  • Phone: 949-246-8043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0205X
TaxonomyPh.D. Medical Genetics Physician
License Number2011071
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: