Provider Demographics
NPI:1417481615
Name:HASHEMI-SABOUR, ASHKAN (PA-C)
Entity Type:Individual
Prefix:
First Name:ASHKAN
Middle Name:
Last Name:HASHEMI-SABOUR
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4472 S EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-7825
Mailing Address - Country:US
Mailing Address - Phone:702-326-3509
Mailing Address - Fax:
Practice Address - Street 1:4472 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-7825
Practice Address - Country:US
Practice Address - Phone:702-326-3509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-13
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA1836363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant