Provider Demographics
NPI:1437287364
Name:KHAJAVI, PARIVASH (DMD)
Entity Type:Individual
Prefix:MRS
First Name:PARIVASH
Middle Name:
Last Name:KHAJAVI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14212 AMBAUM BLVD SW STE 305
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-1437
Mailing Address - Country:US
Mailing Address - Phone:206-988-3968
Mailing Address - Fax:206-988-3969
Practice Address - Street 1:14212 AMBAUM BLVD
Practice Address - Street 2:SW #305
Practice Address - City:BURIEM
Practice Address - State:WA
Practice Address - Zip Code:98166
Practice Address - Country:US
Practice Address - Phone:206-988-3968
Practice Address - Fax:206-988-3969
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA7998122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA911886OtherUNITED CONCORDIA
WA5037023Medicaid
WA5037023Medicaid