Provider Demographics
NPI:1235507534
Name:INTERNAL MEDICINE & CARDIOLOGY INC PS
Entity Type:Organization
Organization Name:INTERNAL MEDICINE & CARDIOLOGY INC PS
Other - Org Name:INTERNAL MEDICINE & CARDIOLOGY INC PS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SASSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SANAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-546-3105
Mailing Address - Street 1:1207 N 200TH ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-3213
Mailing Address - Country:US
Mailing Address - Phone:206-546-3105
Mailing Address - Fax:206-546-3211
Practice Address - Street 1:1207 N 200TH ST
Practice Address - Street 2:SUITE 210
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-3213
Practice Address - Country:US
Practice Address - Phone:206-546-3105
Practice Address - Fax:206-546-3211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-03
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00009454174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty