Provider Demographics
NPI:1831703438
Name:AL SULTAN, HAIDER A
Entity type:Individual
Prefix:
First Name:HAIDER
Middle Name:A
Last Name:AL SULTAN
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 1:28002 15TH AVE S
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6103
Mailing Address - Country:US
Mailing Address - Phone:206-790-3323
Mailing Address - Fax:
Practice Address - Street 1:28002 15TH AVE S
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6103
Practice Address - Country:US
Practice Address - Phone:206-790-3323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171R00000X
WAMA3355171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter