Provider Demographics
NPI:1194268987
Name:J H DAULAT DO PC
Entity type:Organization
Organization Name:J H DAULAT DO PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JALDEEP
Authorized Official - Middle Name:H
Authorized Official - Last Name:DAULAT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:702-654-3187
Mailing Address - Street 1:9750 W SKYE CANYON PARK DR
Mailing Address - Street 2:SUITE 160 BOX103
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89166
Mailing Address - Country:US
Mailing Address - Phone:702-683-1727
Mailing Address - Fax:702-974-0440
Practice Address - Street 1:3975 S DURANGO DR STE 107
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-4156
Practice Address - Country:US
Practice Address - Phone:702-628-5333
Practice Address - Fax:702-487-3599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-28
Last Update Date:2023-03-03
Deactivation Date:2021-07-07
Deactivation Code:
Reactivation Date:2021-08-17
Provider Licenses
StateLicense IDTaxonomies
NV363207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty