Provider Demographics
NPI:1669763488
Name:KHARAZI, PEJMAN (MD)
Entity type:Individual
Prefix:
First Name:PEJMAN
Middle Name:
Last Name:KHARAZI
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 1:201 N BUFFALO DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-0373
Mailing Address - Country:US
Mailing Address - Phone:702-242-2737
Mailing Address - Fax:022-553-1707
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
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-27
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NV16834207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program