MEDICARE: IRAJ KASIMI D.M.D.

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	122300000X	Dentist	6537	OK
2	122300000X	Dentist	64215	CA

General Provider Information

NPI Number	:	1568803534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRAJ KASIMI D.M.D.

Provider Business Mailing Address
First Line	:	3350 NOVAT ST STE 145
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-8722
Country	:	US
Telephone Number	:	702-395-1088
Fax Number	:

Provider Business Practice Location Address
First Line	:	3350 NOVAT ST STE 145
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-8722
Country	:	US
Telephone Number	:	702-395-1088
Fax Number	:

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

Provider Enumeration Date	:	07/08/2013
Last Update Date	:	10/04/2019

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