Provider Demographics
NPI:1609102706
Name:NORTHSTAR SURGICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:NORTHSTAR SURGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KHASHAYAR
Authorized Official - Middle Name:
Authorized Official - Last Name:DEHGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-531-9518
Mailing Address - Street 1:2150 N 107TH ST
Mailing Address - Street 2:SUITE 520
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-1305
Mailing Address - Country:US
Mailing Address - Phone:425-836-3900
Mailing Address - Fax:425-836-3907
Practice Address - Street 1:2150 N 107TH ST
Practice Address - Street 2:SUITE 520
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-1305
Practice Address - Country:US
Practice Address - Phone:425-836-3900
Practice Address - Fax:425-836-3907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-23
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00047758208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty