Provider Demographics
NPI:1437683968
Name:JAHAN, AZMI RAMIN (MD)
Entity Type:Individual
Prefix:
First Name:AZMI
Middle Name:RAMIN
Last Name:JAHAN
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 1:1500 W ASHLAND ST
Mailing Address - Street 2:
Mailing Address - City:NEVADA
Mailing Address - State:MO
Mailing Address - Zip Code:64772-1710
Mailing Address - Country:US
Mailing Address - Phone:816-514-1215
Mailing Address - Fax:
Practice Address - Street 1:1500 W ASHLAND ST
Practice Address - Street 2:
Practice Address - City:NEVADA
Practice Address - State:MO
Practice Address - Zip Code:64772-1710
Practice Address - Country:US
Practice Address - Phone:417-448-5623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-11
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA871782084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAMD-51041OtherIOWA MEDICAL LICENSE
VA0101278620OtherVIRGINIA MEDICAL LICENSE
FL147650OtherFLORIDA MEDICAL LICENSE
MO2022039053OtherMISSOURI MEDICAL LICENSE
WI81261OtherWISCONSIN MEDICAL LICENSE
GA87178OtherGEORGIA MEDICAL LICENSE