Healthcare Provider Details

I. General information

NPI: 1063100394
Provider Name (Legal Business Name): AJ MEDICAL SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2023
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6315 S RAINBOW BLVD
LAS VEGAS NV
89118-3216
US

IV. Provider business mailing address

7251 W CHARLESTON BLVD
LAS VEGAS NV
89117-1632
US

V. Phone/Fax

Practice location:
  • Phone: 702-497-5971
  • Fax: 702-233-1793
Mailing address:
  • Phone: 702-497-5971
  • Fax: 702-233-1793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: AZAM HAKIM
Title or Position: OFFICER
Credential:
Phone: 702-497-5971