Provider Demographics
NPI:1689706822
Name:POURMASIHA, KATAYOUN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATAYOUN
Middle Name:
Last Name:POURMASIHA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 PAYNE ST
Mailing Address - Street 2:SUITE NUMBER 101
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22041-2313
Mailing Address - Country:US
Mailing Address - Phone:703-578-0000
Mailing Address - Fax:703-578-8200
Practice Address - Street 1:3400 PAYNE ST
Practice Address - Street 2:SUITE NUMBER 101
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22041-2313
Practice Address - Country:US
Practice Address - Phone:703-578-0000
Practice Address - Fax:703-578-8200
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410376122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist