Healthcare Provider Details

I. General information

NPI: 1417463720
Provider Name (Legal Business Name): AMADI AESTHETICS PLASTIC SURGERY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2017
Last Update Date: 12/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1503 2ND AVE W
SEATTLE WA
98119-3007
US

IV. Provider business mailing address

1503 2ND AVE W
SEATTLE WA
98119-3007
US

V. Phone/Fax

Practice location:
  • Phone: 206-216-4500
  • Fax: 206-216-4501
Mailing address:
  • Phone: 206-216-4500
  • Fax: 206-216-4501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA10005371
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License NumberMD000039588
License Number StateWA

VIII. Authorized Official

Name: DR. ARASH JIAN AMADI
Title or Position: OWNER
Credential: MD
Phone: 206-216-4500