Healthcare Provider Details

I. General information

NPI: 1891552469
Provider Name (Legal Business Name): ASHKON BASHIRI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/29/2024
Last Update Date: 10/04/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 PRESIDENTS CIR
SALT LAKE CITY UT
84112-9049
US

IV. Provider business mailing address

3909 SEAHAM CT
PLANO TX
75025-2073
US

V. Phone/Fax

Practice location:
  • Phone: 972-836-5804
  • Fax:
Mailing address:
  • Phone: 972-836-5804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: