Basic Information
| Provider Information | |||||||||
| NPI: | 1972072106 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AKBARI | ||||||||
| FirstName: | KATAYOUN | ||||||||
| MiddleName: | |||||||||
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| Credential: | PHYSICIAN ASSISTANT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4755 FAUNTLEROY WAY SW | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981164647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062010551 | ||||||||
| FaxNumber: | 2062010552 | ||||||||
| Practice Location | |||||||||
| Address1: | 4755 FAUNTLEROY WAY SW | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981164647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062010551 | ||||||||
| FaxNumber: | 2062010552 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2018 | ||||||||
| LastUpdateDate: | 11/12/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA60916865 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 2124260 | 05 | WA | MEDICAID |