Provider Demographics
NPI:1851835433
Name:YAZDANPANAH, HOSSEIN
Entity Type:Individual
Prefix:
First Name:HOSSEIN
Middle Name:
Last Name:YAZDANPANAH
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 1:1109 S THOMAS ST APT 22
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-3605
Mailing Address - Country:US
Mailing Address - Phone:571-275-4328
Mailing Address - Fax:
Practice Address - Street 1:1109 S THOMAS ST APT 22
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-3605
Practice Address - Country:US
Practice Address - Phone:571-275-4328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-15
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide