Healthcare Provider Details

I. General information

NPI: 1366650186
Provider Name (Legal Business Name): AFSHIN DEYHIMPANAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 08/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 S ALMA SCHOOL RD SUITE # 1, PMB #178
CHANDLER AZ
85286-7075
US

IV. Provider business mailing address

2040 S ALMA SCHOOL RD SUITE # 1, PMB #178
CHANDLER AZ
85286-7075
US

V. Phone/Fax

Practice location:
  • Phone: 480-728-3000
  • Fax:
Mailing address:
  • Phone: 480-728-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberE-6175
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number255633
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number41085
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA111794
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: