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General NPI Number Information
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NPI Number | 1548700495
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Entity Type | Individual
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Provider Name | ZEESHAWN MIRZA
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Gender | Male
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Dates
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Enumeration Date | 02/26/2017
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | 527 BOREN AVE N
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City | SEATTLE
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State | WA
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Zip | 98109-5502
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Country | US
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Telephone | 206-274-1211
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Fax |
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Provider Business Mailing Address
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Address Line | 4600 UNION BAY PL NE APT 611
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City | SEATTLE
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State | WA
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Zip | 98105-5557
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Country | US
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Telephone | 732-513-5293
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DE61566846
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License Number State | WA
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