Provider Demographics
NPI:1578671830
Name:DAHAN, MAZEN (MD)
Entity Type:Individual
Prefix:
First Name:MAZEN
Middle Name:
Last Name:DAHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 3RD ST SE STE 200
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3730
Mailing Address - Country:US
Mailing Address - Phone:253-848-7660
Mailing Address - Fax:253-841-1801
Practice Address - Street 1:1420 3RD ST SE STE 200
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3730
Practice Address - Country:US
Practice Address - Phone:253-848-7660
Practice Address - Fax:253-841-1801
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00038984208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics