Provider Demographics
NPI:1962173179
Name:DRSIDSIAHPUSHPSYCHIATRIST LLC
Entity type:Organization
Organization Name:DRSIDSIAHPUSHPSYCHIATRIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:SID
Authorized Official - Middle Name:H
Authorized Official - Last Name:SIAHPUSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-821-1810
Mailing Address - Street 1:12025 115TH AVE NE STE 200
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-6935
Mailing Address - Country:US
Mailing Address - Phone:425-821-1810
Mailing Address - Fax:425-823-1231
Practice Address - Street 1:12025 115TH AVE NE STE 200
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-6935
Practice Address - Country:US
Practice Address - Phone:425-821-1810
Practice Address - Fax:425-823-1231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)