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NPI Code Detail

MEDICARE: DR. MIMI PHAN HAGHSHENAS MD

MEDICARE: DR. MIMI PHAN HAGHSHENAS 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
1390200000XStudent in an Organized Health Care Education/Training ProgramW2724TX

General Provider Information

NPI Number : 1265010763
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MIMI PHAN HAGHSHENAS MD
Provider Business Mailing Address
First Line : 6565 FANNIN ST
Second Line :
City : HOUSTON
State : TX
Zip : 77030-2703
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6565 FANNIN ST
Second Line :
City : HOUSTON
State : TX
Zip : 77030-2703
Country : US
Telephone Number : 713-790-3311
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2021
Last Update Date : 02/20/2026

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