Healthcare Provider Details

I. General information

NPI: 1164429932
Provider Name (Legal Business Name): FARZIN FARHANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: FARZIN FARHANGNEJAD MD

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 10/21/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7251 W LAKE MEAD BLVD STE 300
LAS VEGAS NV
89128-8380
US

IV. Provider business mailing address

9030 W SAHARA AVE SUITE 249
LAS VEGAS NV
89117-5744
US

V. Phone/Fax

Practice location:
  • Phone: 702-629-6992
  • Fax: 702-901-5224
Mailing address:
  • Phone: 702-629-6992
  • Fax: 949-862-2963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number11033
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: