Provider Demographics
NPI:1588120240
Name:BABAK HOOSHMAND MD PLLC
Entity type:Organization
Organization Name:BABAK HOOSHMAND MD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BABAK
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOSHMAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:725-705-2739
Mailing Address - Street 1:PO BOX 530815
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89053-0815
Mailing Address - Country:US
Mailing Address - Phone:702-487-7055
Mailing Address - Fax:
Practice Address - Street 1:4472 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-7825
Practice Address - Country:US
Practice Address - Phone:702-844-6333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-18
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1023380086OtherNPI