=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760834204
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SAHAND VAFADARY M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2016
-----------------------------------------------------
Last Update Date | 03/14/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1075 S IDAHO RD STE 206
-----------------------------------------------------
City | APACHE JUNCTION
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85119-6405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-827-5005
-----------------------------------------------------
Fax | 480-827-5001
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 660 S COOLIDGE ST
-----------------------------------------------------
City | MOSES LAKE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98837-1872
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-793-9715
-----------------------------------------------------
Fax | 509-764-3244
-----------------------------------------------------
=====================================================
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 | 66576
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | MD60916833
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------