MEDICARE: SINA NASRI-CHENIJANI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207YX0007X	Plastic Surgery within the Head & Neck (Otolaryngology) Physician	7859	NV
2	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician	7859	NV

General Provider Information

NPI Number	:	1235108325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SINA NASRI-CHENIJANI MD

Provider Business Mailing Address
First Line	:	5130 S FORT APACHE RD STE 215
Second Line	:	PMB 389
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-1732
Country	:	US
Telephone Number	:	702-804-4729
Fax Number	:	702-804-4737

Provider Business Practice Location Address
First Line	:	3150 N TENAYA WAY STE 340
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0447
Country	:	US
Telephone Number	:	702-804-4729
Fax Number	:	702-804-4737

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	11/08/2022

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