Provider Demographics
NPI:1306585179
Name:KHADEER, MAHIN
Entity type:Individual
Prefix:DR
First Name:MAHIN
Middle Name:
Last Name:KHADEER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2203 PORTER LOOP
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98901-6112
Mailing Address - Country:US
Mailing Address - Phone:425-279-3475
Mailing Address - Fax:
Practice Address - Street 1:2310 LONGFIBRE RD
Practice Address - Street 2:
Practice Address - City:UNION GAP
Practice Address - State:WA
Practice Address - Zip Code:98903-1513
Practice Address - Country:US
Practice Address - Phone:509-454-5242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD61212743152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAOD61212743OtherDEPARTMENT OF HEALTH