Provider Demographics
NPI:1114659976
Name:POURAHMARI, AIMAN (DE 61297295)
Entity type:Individual
Prefix:
First Name:AIMAN
Middle Name:
Last Name:POURAHMARI
Suffix:
Gender:M
Credentials:DE 61297295
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19020 33RD AVE W
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4746
Mailing Address - Country:US
Mailing Address - Phone:425-774-0111
Mailing Address - Fax:
Practice Address - Street 1:19020 33RD AVE W STE 380
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4754
Practice Address - Country:US
Practice Address - Phone:425-774-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2025-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE612972951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice