=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023554185
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | J H DAULAT DO PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2017
-----------------------------------------------------
Last Update Date | 12/28/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 340 FALCON RIDGE PKWY STE 400-404
-----------------------------------------------------
City | MESQUITE
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89027-8850
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-346-5510
-----------------------------------------------------
Fax | 702-346-2557
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9750 W SKYE CANYON PARK DR SUITE 160 BOX 103
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89166
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-683-1727
-----------------------------------------------------
Fax | 702-974-0440
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JALDEEP H DAULAT
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 702-346-5510
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | 363
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------