Provider Demographics
NPI:1396834453
Name:JAZAERI, HASSAN AMIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:HASSAN
Middle Name:AMIN
Last Name:JAZAERI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12900 NE 180TH ST
Mailing Address - Street 2:SUITE210
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-5773
Mailing Address - Country:US
Mailing Address - Phone:425-485-2978
Mailing Address - Fax:425-485-4870
Practice Address - Street 1:12900 NE 180TH ST
Practice Address - Street 2:SUITE210
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-5773
Practice Address - Country:US
Practice Address - Phone:425-485-2978
Practice Address - Fax:425-485-4870
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000098931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice