Provider Demographics
NPI:1790717221
Name:SADRI-TAFAZOLI, FARANAK (MD)
Entity Type:Individual
Prefix:DR
First Name:FARANAK
Middle Name:
Last Name:SADRI-TAFAZOLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22100 BOTHELL EVERETT HWY
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-8431
Mailing Address - Country:US
Mailing Address - Phone:208-416-2932
Mailing Address - Fax:855-673-9190
Practice Address - Street 1:4857 WINNETKA AVE
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-4740
Practice Address - Country:US
Practice Address - Phone:208-416-2932
Practice Address - Fax:855-673-9190
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012733742085R0202X
CAC1708492085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology