MEDICARE: DR. KOUROSH CYRUS GHAFFARI 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	208000000X	Pediatrics Physician	7658	HI

General Provider Information

NPI Number	:	1740489319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KOUROSH CYRUS GHAFFARI M.D.

Provider Business Mailing Address
First Line	:	9850 S MARYLAND PKWY
Second Line	:	5146
City	:	LAS VEGAS
State	:	NV
Zip	:	89183-7146
Country	:	US
Telephone Number	:	702-982-6455
Fax Number	:

Provider Business Practice Location Address
First Line	:	9850 S. MARYLAND PKWY
Second Line	:	5146
City	:	LAS VEGAS
State	:	NV
Zip	:	89183-7146
Country	:	US
Telephone Number	:	702-982-6455
Fax Number	:

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

Provider Enumeration Date	:	07/13/2007
Last Update Date	:	07/13/2007

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