Provider Demographics
NPI:1699406306
Name:ALKHATIB, YAMAN SR
Entity type:Individual
Prefix:
First Name:YAMAN
Middle Name:
Last Name:ALKHATIB
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 NE BLAKELEY ST APT 302
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-3282
Mailing Address - Country:US
Mailing Address - Phone:312-678-7950
Mailing Address - Fax:
Practice Address - Street 1:2301 NE BLAKELEY ST APT 302
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3282
Practice Address - Country:US
Practice Address - Phone:312-678-7950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61294706122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist