Provider Demographics
NPI:1447439682
Name:FARAHANI, HOMAYOUN CAMRAN (MD)
Entity type:Individual
Prefix:
First Name:HOMAYOUN
Middle Name:CAMRAN
Last Name:FARAHANI
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 1:7391 W CHARLESTON BLVD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-1577
Mailing Address - Country:US
Mailing Address - Phone:702-304-2144
Mailing Address - Fax:702-304-2147
Practice Address - Street 1:7391 W CHARLESTON BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1577
Practice Address - Country:US
Practice Address - Phone:702-304-2144
Practice Address - Fax:702-304-2147
Is Sole Proprietor?:No
Enumeration Date:2007-10-24
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA235665207Q00000X, 208M00000X
CAC168138207Q00000X
NV13324208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMT189329OtherMEDICAL LICENSE NUMBER
NV13324OtherNV MED LIC