Provider Demographics
NPI:1174988513
Name:HASSANTASH, SEYED AHMAD (MD)
Entity type:Individual
Prefix:
First Name:SEYED AHMAD
Middle Name:
Last Name:HASSANTASH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 247TH PL NE
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98074-3484
Mailing Address - Country:US
Mailing Address - Phone:512-982-2583
Mailing Address - Fax:
Practice Address - Street 1:227 247TH PL NE
Practice Address - Street 2:
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98074-3484
Practice Address - Country:US
Practice Address - Phone:512-982-2583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-30
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60546447208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA60546447OtherWA MEDICAL LICENSE NUMBER