=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760343511
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DALLAS INTERNAL MEDICINE SPECIALIST
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2025
-----------------------------------------------------
Last Update Date | 11/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7777 FOREST LN STE C608
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75230-6852
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 945-279-7821
-----------------------------------------------------
Fax | 469-621-2209
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7777 FOREST LN STE C608
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75230-6852
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | AFSANEH IGHANI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 945-279-7821
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------