Healthcare Provider Details

I. General information

NPI: 1104497403
Provider Name (Legal Business Name): JASON M. FAGHIH DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2021
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 N 50TH AVE
YAKIMA WA
98908-2862
US

IV. Provider business mailing address

119 N 50TH AVE
YAKIMA WA
98908-2862
US

V. Phone/Fax

Practice location:
  • Phone: 509-965-7909
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDDS106188
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE61171187
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: