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General NPI Number Information
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NPI Number | 1275888125
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Entity Type | Individual
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Provider Name | ELHAM JAVADI
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Gender | Female
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Dates
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Enumeration Date | 07/17/2012
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Last Update Date | 04/04/2016
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Provider Practice Location Address
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Address Line | 8915 14TH AVE S FL 2
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City | SEATTLE
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State | WA
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Zip | 98108-4813
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Country | US
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Telephone | 206-762-3263
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Fax | 206-763-6574
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Provider Business Mailing Address
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Address Line | 5605 LAKEWOOD TOWNE CENTER BLVD SW STE B
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City | LAKEWOOD
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State | WA
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Zip | 98499-3855
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Country | US
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Telephone | 253-200-4706
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DE60232675
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License Number State | WA
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