Provider Demographics
NPI:1801801659
Name:DEHGHAN, KHASHAYAR (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:KHASHAYAR
Middle Name:
Last Name:DEHGHAN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3515 S 15TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1952
Mailing Address - Country:US
Mailing Address - Phone:253-756-0933
Mailing Address - Fax:253-759-6553
Practice Address - Street 1:3515 S 15TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1952
Practice Address - Country:US
Practice Address - Phone:253-756-0933
Practice Address - Fax:253-759-6553
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000477582086S0122X, 2082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH04069Medicare UPIN