Healthcare Provider Details

I. General information

NPI: 1124968581
Provider Name (Legal Business Name): MOHAMMED MUSHTAK KANANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MOHAMMED MUSHTAK TALIB

II. Dates (important events)

Enumeration Date: 03/28/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 BROADWAY
SEATTLE WA
98122-4379
US

IV. Provider business mailing address

747 BROADWAY
SEATTLE WA
98122-4379
US

V. Phone/Fax

Practice location:
  • Phone: 206-386-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMDRE.ML.70115481
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: