MEDICARE: LESLIE CHUN HAJARIZADEH MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	SC.60894125	WA

General Provider Information

NPI Number	:	1265086656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE CHUN HAJARIZADEH MSW

Provider Business Mailing Address
First Line	:	2708 53RD AVE NE
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98422-2931
Country	:	US
Telephone Number	:	503-805-8746
Fax Number	:

Provider Business Practice Location Address
First Line	:	33400 9TH AVE S STE 100
Second Line	:
City	:	FEDERAL WAY
State	:	WA
Zip	:	98003-2607
Country	:	US
Telephone Number	:	206-567-7267
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2019
Last Update Date	:	03/11/2024

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