=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255770152
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BORJIS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/24/2013
-----------------------------------------------------
Last Update Date | 06/24/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 634 7TH AVE
-----------------------------------------------------
City | KIRKLAND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98033-5665
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-699-6152
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11422 NE 86TH ST
-----------------------------------------------------
City | KIRKLAND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98033-5702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-755-7557
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER/PRACTITIONER
-----------------------------------------------------
Name | MR. FARSHAD ANSARI
-----------------------------------------------------
Credential | EAMP (LAC)
-----------------------------------------------------
Telephone | 206-755-7557
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC60328922
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------