Provider Demographics
NPI:1417057316
Name:DOUST, AFSHIN Y (MD)
Entity Type:Individual
Prefix:DR
First Name:AFSHIN
Middle Name:Y
Last Name:DOUST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 370969
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89137-0969
Mailing Address - Country:US
Mailing Address - Phone:702-453-3799
Mailing Address - Fax:702-453-5741
Practice Address - Street 1:26732 CROWN VALLEY PKWY STE 411
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6375
Practice Address - Country:US
Practice Address - Phone:949-282-1671
Practice Address - Fax:949-367-0518
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA134958207R00000X
NV11054207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100504913Medicaid
NVV105345Medicare PIN
NVI18407Medicare UPIN
NV100504913Medicaid