Provider Demographics
NPI:1467624353
Name:HOMAYOUN A. SARAF
Entity Type:Organization
Organization Name:HOMAYOUN A. SARAF
Other - Org Name:HOMAYOUN A. SARAF, M.D., P.S.
Other - Org Type:Other Name
Authorized Official - Title/Position:M.D/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HOMAYOUN
Authorized Official - Middle Name:
Authorized Official - Last Name:AKHAVAN-SARAF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-423-2450
Mailing Address - Street 1:790 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-2315
Mailing Address - Country:US
Mailing Address - Phone:360-423-2450
Mailing Address - Fax:360-425-4969
Practice Address - Street 1:790 14TH AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2315
Practice Address - Country:US
Practice Address - Phone:360-423-2450
Practice Address - Fax:360-425-4969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00034832174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1103548Medicaid
WAAB32954OtherMEDICARE GROUP PIN
WAAB32955Medicare PIN
WAAB32954OtherMEDICARE GROUP PIN