Provider Demographics
NPI:1588235709
Name:PARASTESH, KOUROSH
Entity Type:Individual
Prefix:
First Name:KOUROSH
Middle Name:
Last Name:PARASTESH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1427 SW 352ND CT
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-6944
Mailing Address - Country:US
Mailing Address - Phone:206-489-9994
Mailing Address - Fax:
Practice Address - Street 1:1427 SW 352ND CT
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023-6944
Practice Address - Country:US
Practice Address - Phone:206-489-9994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-08
Last Update Date:2023-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA390200000X
WAMA4305171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program