Provider Demographics
NPI:1285890038
Name:SABZPOUSHAN, AMIR HOSSEIN (MD)
Entity type:Individual
Prefix:DR
First Name:AMIR
Middle Name:HOSSEIN
Last Name:SABZPOUSHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2756
Mailing Address - Country:US
Mailing Address - Phone:206-625-7180
Mailing Address - Fax:206-341-0447
Practice Address - Street 1:1100 9TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2756
Practice Address - Country:US
Practice Address - Phone:206-625-7180
Practice Address - Fax:206-341-0447
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005013470207R00000X
IAMD-43532207R00000X
WAMD60789740207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1285890038Medicaid
MOP00769835OtherRAILROAD MEDICARE
MOP00769835OtherRAILROAD MEDICARE