Provider Demographics
NPI:1114502564
Name:SANEI MOGHADDAM, ALI (MD, ABFM, CCFP, MRCS)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:
Last Name:SANEI MOGHADDAM
Suffix:
Gender:M
Credentials:MD, ABFM, CCFP, MRCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5416 SNOW GOOSE LN UNIT 405
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:WA
Mailing Address - Zip Code:98230-6316
Mailing Address - Country:US
Mailing Address - Phone:425-515-9022
Mailing Address - Fax:604-200-5047
Practice Address - Street 1:5416 SNOW GOOSE LN UNIT 405
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:WA
Practice Address - Zip Code:98230-6316
Practice Address - Country:US
Practice Address - Phone:425-515-9022
Practice Address - Fax:604-200-5047
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-16
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61075057207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty