Healthcare Provider Details

I. General information

NPI: 1114440641
Provider Name (Legal Business Name): KIAN JOHN JAFARINEJAD H.I.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16320 SE MILL PLAIN BLVD STE 103
VANCOUVER WA
98684-8918
US

IV. Provider business mailing address

16320 SE MILL PLAIN BLVD STE 103
VANCOUVER WA
98684-8918
US

V. Phone/Fax

Practice location:
  • Phone: 360-256-1814
  • Fax: 360-882-7979
Mailing address:
  • Phone: 360-256-1814
  • Fax: 360-882-7979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: