Provider Demographics
NPI:1942415823
Name:DORAFSHAR, AMIR HOSSEIN (MD)
Entity Type:Individual
Prefix:DR
First Name:AMIR
Middle Name:HOSSEIN
Last Name:DORAFSHAR
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 1:23055 SHERMAN WAY UNIT 4245
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91308-7015
Mailing Address - Country:US
Mailing Address - Phone:312-371-4248
Mailing Address - Fax:
Practice Address - Street 1:60 E DELAWARE PL STE 1430
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-1495
Practice Address - Country:US
Practice Address - Phone:312-278-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-13
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD36424208200000X
IL036.1143292086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD192370ZAK6Medicare PIN