Healthcare Provider Details

I. General information

NPI: 1679096010
Provider Name (Legal Business Name): SARA LADAN HOJJATIE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2017
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4707 S 19TH ST
TACOMA WA
98405-1157
US

IV. Provider business mailing address

4707 S 19TH ST
TACOMA WA
98405-1157
US

V. Phone/Fax

Practice location:
  • Phone: 253-248-2020
  • Fax:
Mailing address:
  • Phone: 253-248-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD.MD.61591299
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: