Provider Demographics
NPI:1790166981
Name:SOLTAN, ASHKAN (MD)
Entity Type:Individual
Prefix:
First Name:ASHKAN
Middle Name:
Last Name:SOLTAN
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 560602
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75356-0602
Mailing Address - Country:US
Mailing Address - Phone:469-666-1730
Mailing Address - Fax:
Practice Address - Street 1:1430 REGAL ROW STE 300B
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-3625
Practice Address - Country:US
Practice Address - Phone:469-666-1730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-12
Last Update Date:2020-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS50772084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty