Provider Demographics
NPI:1245380468
Name:KAZEMI, ASSADULLAH (MD)
Entity Type:Individual
Prefix:DR
First Name:ASSADULLAH
Middle Name:
Last Name:KAZEMI
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 1:4515 MARTIN LUTHER KING JR WAY S
Mailing Address - Street 2:STE 100
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-2183
Mailing Address - Country:US
Mailing Address - Phone:206-320-5325
Mailing Address - Fax:206-320-5326
Practice Address - Street 1:4515 MLK WAY
Practice Address - Street 2:PROVIDENCE ELDERPLACE,
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108
Practice Address - Country:US
Practice Address - Phone:206-320-5325
Practice Address - Fax:206-320-5326
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00031515207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8203192Medicaid
WA8203192Medicaid
WA217122202Medicare ID - Type Unspecified