Healthcare Provider Details

I. General information

NPI: 1730366659
Provider Name (Legal Business Name): AFSHIN Y DOUST MD A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2008
Last Update Date: 07/30/2021
Certification Date: 07/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 N TENAYA WAY
LAS VEGAS NV
89128-0436
US

IV. Provider business mailing address

PO BOX 370969
LAS VEGAS NV
89137-0969
US

V. Phone/Fax

Practice location:
  • Phone: 702-453-3799
  • Fax: 702-453-5741
Mailing address:
  • Phone: 702-453-3799
  • Fax: 702-453-5741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number11054
License Number StateNV

VIII. Authorized Official

Name: AFSHIN Y DOUST
Title or Position: OWNER
Credential: MD
Phone: 702-204-5596