Provider Demographics
NPI:1912292046
Name:KHATAMI, DAVID BEHNAM (MD, PHD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:BEHNAM
Last Name:KHATAMI
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:PO BOX 94624
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-6924
Mailing Address - Country:US
Mailing Address - Phone:800-634-4064
Mailing Address - Fax:952-513-6880
Practice Address - Street 1:12112 115TH AVE NE STE B
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-6958
Practice Address - Country:US
Practice Address - Phone:425-821-3472
Practice Address - Fax:425-820-4115
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-16
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.059524207R00000X
MA2610622085R0202X
WAMD608185312085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMD60818531OtherSTATE LICENSE