Provider Demographics
NPI:1326083650
Name:KHOSHKHESAL-DARVISH, NOOSHIN (ND)
Entity Type:Individual
Prefix:DR
First Name:NOOSHIN
Middle Name:
Last Name:KHOSHKHESAL-DARVISH
Suffix:
Gender:F
Credentials:ND
Other - Prefix:DR
Other - First Name:NOOSHIN
Other - Middle Name:K
Other - Last Name:DARVISH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ND
Mailing Address - Street 1:1200 116TH AVE NE STE C
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3802
Mailing Address - Country:US
Mailing Address - Phone:425-451-0404
Mailing Address - Fax:425-462-8919
Practice Address - Street 1:1200 116TH AVE NE STE C
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3802
Practice Address - Country:US
Practice Address - Phone:425-451-0404
Practice Address - Fax:425-462-8919
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00000748175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath