Provider Demographics
NPI:1801674932
Name:HOSSEINZADEH, BAHAR
Entity type:Individual
Prefix:
First Name:BAHAR
Middle Name:
Last Name:HOSSEINZADEH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3970 W LAKE SAMMAMISH PKWY NE APT 310
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-5868
Mailing Address - Country:US
Mailing Address - Phone:206-799-9637
Mailing Address - Fax:
Practice Address - Street 1:3970 W LAKE SAMMAMISH PKWY NE APT 310
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-5868
Practice Address - Country:US
Practice Address - Phone:206-799-9637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-19
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician