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General NPI Number Information
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NPI Number | 1639116023
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Entity Type | Individual
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Provider Name | ABOLGHASEM JAVAHERIAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/02/2006
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Last Update Date | 07/23/2025
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Provider Practice Location Address
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Address Line | 8672 INDIGO SPRING RD
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City | LAS VEGAS
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State | NV
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Zip | 89139-7557
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Country | US
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Telephone | 715-379-2883
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Fax |
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Provider Business Mailing Address
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Address Line | 8672 INDIGO SPRING RD
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City | LAS VEGAS
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State | NV
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Zip | 89139-7557
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Country | US
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Telephone | 715-379-2883
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 25426
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 34839
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License Number State | WI
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