Healthcare Provider Details

I. General information

NPI: 1083227458
Provider Name (Legal Business Name): KHURRAM FAHIM DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2020
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3880 W LAKE MEAD BLVD STE 100
NORTH LAS VEGAS NV
89032-5201
US

IV. Provider business mailing address

8065 CORONADO COAST ST
LAS VEGAS NV
89139-6193
US

V. Phone/Fax

Practice location:
  • Phone: 702-626-0526
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7395
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: