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NPI Code Detail

MEDICARE: HOSSEINION FAMILY MEDICINE

MEDICARE: HOSSEINION FAMILY MEDICINE
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
1207Q00000XFamily Medicine PhysicianMD26562OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MD26562OTHERORMEDICAL PROFESSIONAL LICENSE

General Provider Information

NPI Number : 1295044485
Entity Type Code : Organization
Provider Name (Legal Business Name) : HOSSEINION FAMILY MEDICINE
Provider Business Mailing Address
First Line : PO BOX 97115
Second Line :
City : LAKEWOOD
State : WA
Zip : 98497-0115
Country : US
Telephone Number : 253-588-7911
Fax Number : 253-365-6299
Provider Business Practice Location Address
First Line : 3942 SE HAWTHORNE BLVD
Second Line :
City : PORTLAND
State : OR
Zip : 97214-5242
Country : US
Telephone Number : 503-234-2070
Fax Number : 503-235-3956
Authorized Official
Title or Position : PROVIDER/OWNER
Name : DR. SHAHRAM HOSSEINION
Credential : MD
Telephone Number : 503-234-2070
Provider Enumeration Date : 10/05/2010
Last Update Date : 11/10/2015

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