Provider Demographics
NPI:1477848943
Name:ANSARI, FARSHAD (LAC)
Entity Type:Individual
Prefix:MR
First Name:FARSHAD
Middle Name:
Last Name:ANSARI
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11422 NE 86TH ST
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-5702
Mailing Address - Country:US
Mailing Address - Phone:425-827-0583
Mailing Address - Fax:
Practice Address - Street 1:634 7TH AVE
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-5665
Practice Address - Country:US
Practice Address - Phone:425-822-2858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2013-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60328922171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist