Basic Information
Provider Information
NPI: 1134277510
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SHAHRASBI
FirstName: ABDOLHOSSEIN
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: DDS,MS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6950 NE CAMPUS WAY
Address2:  
City: HILLSBORO
State: OR
PostalCode: 971245611
CountryCode: US
TelephoneNumber: 5039522164
FaxNumber: 5035264418
Practice Location
Address1: 626 120TH AVE NE
Address2: SUITE B210
City: BELLEVUE
State: WA
PostalCode: 980053077
CountryCode: US
TelephoneNumber: 4254531547
FaxNumber: 4256460974
Other Information
ProviderEnumerationDate: 01/08/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
122300000XDE9000WAY Dental ProvidersDentist 

No ID Information.


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