Provider Demographics
NPI:1205589470
Name:PEJMAN KHARAZI MD PROF LLC
Entity type:Organization
Organization Name:PEJMAN KHARAZI MD PROF LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:PEJMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KHARAZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-980-3074
Mailing Address - Street 1:PO BOX 370396
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89137-0396
Mailing Address - Country:US
Mailing Address - Phone:702-425-6125
Mailing Address - Fax:702-208-2202
Practice Address - Street 1:1900 E DESERT INN RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-3211
Practice Address - Country:US
Practice Address - Phone:702-425-6125
Practice Address - Fax:702-208-2202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-28
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty