Provider Demographics
NPI:1659791770
Name:HOSSEINI GHOMI, REZA (MD, MSE)
Entity Type:Individual
Prefix:
First Name:REZA
Middle Name:
Last Name:HOSSEINI GHOMI
Suffix:
Gender:M
Credentials:MD, MSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1959 NE PACIFIC ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1959 NE PACIFIC ST PSYCHIATRY RESIDENCY PROGRAM
Practice Address - Street 2:BOX 356560
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-6560
Practice Address - Country:US
Practice Address - Phone:206-314-8803
Practice Address - Fax:844-207-1286
Is Sole Proprietor?:No
Enumeration Date:2014-04-16
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD606648152084B0040X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & Neuropsychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry