Provider Demographics
NPI:1205436177
Name:JAFARI, MEHDI F
Entity type:Individual
Prefix:
First Name:MEHDI
Middle Name:F
Last Name:JAFARI
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 1:26909 SAXON CT
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-7110
Mailing Address - Country:US
Mailing Address - Phone:206-595-7369
Mailing Address - Fax:
Practice Address - Street 1:26909 SAXON CT
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-7110
Practice Address - Country:US
Practice Address - Phone:206-595-7369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA4872Medicaid