Provider Demographics
NPI:1700084720
Name:K.F.B.H., LLC
Entity Type:Organization
Organization Name:K.F.B.H., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KHAIRALLAH
Authorized Official - Middle Name:
Authorized Official - Last Name:FAYAZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-327-5747
Mailing Address - Street 1:1350 KELSO DUNES AVE
Mailing Address - Street 2:APT. 321
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-7816
Mailing Address - Country:US
Mailing Address - Phone:702-485-6612
Mailing Address - Fax:
Practice Address - Street 1:1090 WIGWAM PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074
Practice Address - Country:US
Practice Address - Phone:702-454-0201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV110612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV001700084720Medicaid
NV001700084720Medicaid