=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689306177
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HESAM JOSHAGHANI MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/24/2022
-----------------------------------------------------
Last Update Date | 12/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 118 S WHITCOMB AVE
-----------------------------------------------------
City | TONASKET
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98855-9287
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-486-3191
-----------------------------------------------------
Fax | 509-223-1743
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 203 S WESTERN AVE
-----------------------------------------------------
City | TONASKET
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98855-8803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-486-3191
-----------------------------------------------------
Fax | 509-223-1743
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | MD70045371
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------