Provider Demographics
NPI:1316936099
Name:MOINPOUR, YASS (MD)
Entity type:Individual
Prefix:DR
First Name:YASS
Middle Name:
Last Name:MOINPOUR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4033 TALBOT RD S
Mailing Address - Street 2:MEDICAL ARTS CENTER, SUITE 200
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5772
Mailing Address - Country:US
Mailing Address - Phone:425-271-5437
Mailing Address - Fax:425-656-4212
Practice Address - Street 1:4033 TALBOT RD S
Practice Address - Street 2:MEDICAL ARTS CENTER, SUITE 200
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5772
Practice Address - Country:US
Practice Address - Phone:425-271-5437
Practice Address - Fax:425-656-4212
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00036618208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8237026Medicaid
WA8237026Medicaid
WAH32688Medicare UPIN