Provider Demographics
NPI:1932632205
Name:JAFARI, PUYA
Entity Type:Individual
Prefix:
First Name:PUYA
Middle Name:
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 1:425 2ND ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-2003
Mailing Address - Country:US
Mailing Address - Phone:202-469-4699
Mailing Address - Fax:622-214-6201
Practice Address - Street 1:425 2ND ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-2003
Practice Address - Country:US
Practice Address - Phone:202-508-0500
Practice Address - Fax:662-214-6201
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-04
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC048437207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program