Provider Demographics
NPI:1285943647
Name:MUMIN, YUSUF MALIK (MD)
Entity type:Individual
Prefix:DR
First Name:YUSUF
Middle Name:MALIK
Last Name:MUMIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3227 MEADE AVE
Mailing Address - Street 2:STE 3B
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-0074
Mailing Address - Country:US
Mailing Address - Phone:702-772-3663
Mailing Address - Fax:702-829-5426
Practice Address - Street 1:3227 MEADE AVE
Practice Address - Street 2:SUITE 3B
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-0074
Practice Address - Country:US
Practice Address - Phone:702-772-3663
Practice Address - Fax:702-829-5426
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-04
Last Update Date:2017-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV176892084P0800X
NV169872084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I262550Medicare PIN