Provider Demographics
NPI:1407252976
Name:GHAZAVI, HAMIDREZA (ACUPUNCTURIST)
Entity Type:Individual
Prefix:
First Name:HAMIDREZA
Middle Name:
Last Name:GHAZAVI
Suffix:
Gender:M
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7221 CAROL LN
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-3715
Mailing Address - Country:US
Mailing Address - Phone:312-834-9085
Mailing Address - Fax:
Practice Address - Street 1:801 N QUINCY ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-1999
Practice Address - Country:US
Practice Address - Phone:703-527-5492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-11
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000738171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty