1821010893 NPI number — SEAN LAGHAEIAN, DPM

Table of content: (NPI 1821010893)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821010893 NPI number — SEAN LAGHAEIAN, DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SEAN LAGHAEIAN, DPM
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821010893
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/17/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9909 224TH ST E
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
GRAHAM
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98338-7086
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-875-7375
Provider Business Mailing Address Fax Number:
253-875-7371

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9909 224TH ST E
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
GRAHAM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98338-7086
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-875-7375
Provider Business Practice Location Address Fax Number:
253-875-7371
Provider Enumeration Date:
07/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LAGHAEIAN
Authorized Official First Name:
SEAN
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
253-875-7375

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  PO00000658 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8800025 . This is a "INDIVIDUAL MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1112978 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1184640575 . This is a "INDIVIDUAL NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1821010893 . This is a "GROUP NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00144949 . This is a "MEDICARE - RAILROAD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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