Provider Demographics
NPI:1821582537
Name:SARHANGI IZAD MOOSA, FARZAN
Entity Type:Individual
Prefix:
First Name:FARZAN
Middle Name:
Last Name:SARHANGI IZAD MOOSA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 2ND AVE APT 203
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-6261
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:530 2ND AVE
Practice Address - Street 2:APT 203
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-6261
Practice Address - Country:US
Practice Address - Phone:310-866-8599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-15
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60857528122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist