Provider Demographics
NPI:1447279468
Name:KHAKPOUR, DORRINE (RD)
Entity type:Individual
Prefix:
First Name:DORRINE
Middle Name:
Last Name:KHAKPOUR
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24366
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-0366
Mailing Address - Country:US
Mailing Address - Phone:206-598-0502
Mailing Address - Fax:206-598-0516
Practice Address - Street 1:4225 ROOSEVELT WAY
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-0001
Practice Address - Country:US
Practice Address - Phone:206-598-4882
Practice Address - Fax:206-598-4976
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00001162133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0161267OtherLABOR & INDUSTRY
WA8344517Medicaid
WAU53872OtherREGENCE BLUESHIELD
WAAB33443Medicare PIN
WAU53872OtherREGENCE BLUESHIELD