=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417463720
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMADI AESTHETICS PLASTIC SURGERY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/21/2017
-----------------------------------------------------
Last Update Date | 12/21/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1503 2ND AVE W
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98119-3007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-216-4500
-----------------------------------------------------
Fax | 206-216-4501
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1503 2ND AVE W
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98119-3007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-216-4500
-----------------------------------------------------
Fax | 206-216-4501
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ARASH JIAN AMADI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 206-216-4500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA10005371
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207WX0200X
-----------------------------------------------------
Taxonomy Name | Ophthalmic Plastic and Reconstructive Surgery Physician
-----------------------------------------------------
License Number | MD000039588
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------