Provider Demographics
NPI:1679019681
Name:OSAFI, JAVID FARAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAVID
Middle Name:FARAN
Last Name:OSAFI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19020 BOTHELL WAY NE STE C
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-2996
Mailing Address - Country:US
Mailing Address - Phone:702-612-0687
Mailing Address - Fax:
Practice Address - Street 1:19020 BOTHELL WAY NE STE C
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-2996
Practice Address - Country:US
Practice Address - Phone:702-612-0687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-13
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE607450791223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2080083Medicaid