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General NPI Number Information
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NPI Number | 1104517564
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Entity Type | Individual
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Provider Name | MR. PEZHMAN AHMADI
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Gender | Male
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Dates
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Enumeration Date | 05/17/2023
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Last Update Date | 07/30/2024
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Provider Practice Location Address
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Address Line | 13030 MILITARY RD S FL 2
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City | TUKWILA
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State | WA
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Zip | 98168-3085
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Country | US
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Telephone | 206-839-3600
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Fax |
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Provider Business Mailing Address
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Address Line | 1203 N 10TH PL APT 1323
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City | RENTON
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State | WA
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Zip | 98057-5467
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Country | US
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Telephone | 831-710-5987
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | PR61549434
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License Number State | WA
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