=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265015986
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROHAM SALMAN ROGHANI MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/30/2021
-----------------------------------------------------
Last Update Date | 06/28/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3901 RAINBOW BLVD # MS 1023
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66160-8500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-588-6019
-----------------------------------------------------
Fax | 913-588-3975
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 39000 BOB HOPE DR
-----------------------------------------------------
City | RANCHO MIRAGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92270-3221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-333-1813
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | 94-11967
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------