Provider Demographics
NPI:1205005295
Name:DASHTI, JAMAL (HIS, IHS)
Entity Type:Individual
Prefix:MR
First Name:JAMAL
Middle Name:
Last Name:DASHTI
Suffix:
Gender:M
Credentials:HIS, IHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 132ND ST SE
Mailing Address - Street 2:SUITE F
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-7140
Mailing Address - Country:US
Mailing Address - Phone:425-357-8700
Mailing Address - Fax:425-357-8428
Practice Address - Street 1:2003 132ND ST SE
Practice Address - Street 2:SUITE F
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-7140
Practice Address - Country:US
Practice Address - Phone:425-357-8700
Practice Address - Fax:425-357-8428
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHA00002879237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9058215Medicare PIN