Provider Demographics
NPI:1164429932
Name:FARHANG, FARZIN (MD)
Entity Type:Individual
Prefix:DR
First Name:FARZIN
Middle Name:
Last Name:FARHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:FARZIN
Other - Middle Name:
Other - Last Name:FARHANGNEJAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9030 W SAHARA AVE
Mailing Address - Street 2:SUITE 249
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-5744
Mailing Address - Country:US
Mailing Address - Phone:702-629-6992
Mailing Address - Fax:949-862-2963
Practice Address - Street 1:7251 W LAKE MEAD BLVD STE 300
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-8380
Practice Address - Country:US
Practice Address - Phone:702-629-6992
Practice Address - Fax:702-901-5224
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11033208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVNV1468OtherBLUE CROSS BLUE SHIELD
NV100503987Medicaid
NVV105234Medicare PIN
NVNV1468OtherBLUE CROSS BLUE SHIELD
NVV40648Medicare PIN