Provider Demographics
NPI:1558363176
Name:HUSSAIN, SADAF (MD)
Entity type:Individual
Prefix:
First Name:SADAF
Middle Name:
Last Name:HUSSAIN
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 1:222 STATE AVE N
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-4544
Mailing Address - Country:US
Mailing Address - Phone:253-372-7780
Mailing Address - Fax:253-372-7873
Practice Address - Street 1:222 STATE AVE N
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-4544
Practice Address - Country:US
Practice Address - Phone:253-372-7780
Practice Address - Fax:253-372-7873
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00047346207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100120630CMedicaid
OK100768880IMedicaid
OK100768880IMedicaid
241424406Medicare ID - Type Unspecified