Provider Demographics
NPI:1992141162
Name:AL BUSTANI, NAJWA JAFFAR (MD)
Entity type:Individual
Prefix:
First Name:NAJWA
Middle Name:JAFFAR
Last Name:AL BUSTANI
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 1:1959 NE PACIFIC ST BOX 356169
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-6169
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1959 NE PACIFIC ST
Practice Address - Street 2:UNIVERSITY OF WA DEPT OF NEUROLOGY
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-6465
Practice Address - Country:US
Practice Address - Phone:206-616-5207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-15
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAFE60361497204R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA403410Medicare UPIN