Healthcare Provider Details

I. General information

NPI: 1417057316
Provider Name (Legal Business Name): AFSHIN Y DOUST M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 10/21/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26732 CROWN VALLEY PKWY STE 411
MISSION VIEJO CA
92691-6375
US

IV. Provider business mailing address

PO BOX 370969
LAS VEGAS NV
89137-0969
US

V. Phone/Fax

Practice location:
  • Phone: 949-282-1671
  • Fax: 949-367-0518
Mailing address:
  • Phone: 702-453-3799
  • Fax: 702-453-5741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number134958
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number11054
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: