NPIMap

Organization Active NPI

J H Daulat DO PC

Doing business as Mohave Dermatology

  • Dermatology Physician
  • Las Vegas, NV
National Provider Identifier
1194268987
Registry record updated Mar 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
363 Issued in NV
Legal business name
J H DAULAT DO PC
Doing business as
Mohave Dermatology
Practice address
3975 S Durango Dr Ste 107
Las Vegas, NV 89147-4156
Phone
(702) 628-5333
Fax
(702) 487-3599
NPI assigned
Nov 28, 2016
Reactivated
Aug 17, 2021
Last updated
Mar 3, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jaldeep H Daulat, DONPI 1114949492
Title
Owner
Phone
(702) 654-3187

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 363 NV Primary

Addresses

Primary practice location

3975 S Durango Dr Ste 107
Las Vegas, NV 89147-4156

Mailing address

9750 W Skye Canyon Park Dr
Suite 160 Box103
Las Vegas, NV 89166
Phone (702) 683-1727

Other practice location 1

3975 S Durango Dr Ste 107
Las Vegas, NV 89147-4156
Phone (702) 628-5333

Other names 1

  • MOHAVE DERMATOLOGY Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL MohaveDerm.ema

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170124000506 NV Part B Supplier - Clinic/Group Practice 0143502328 Receives reassigned benefits from 8 practitioners
Practice locations: Las Vegas, NV; Pahrump, NV; Mesquite, NV

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
29D2271051Mohave Dermatology - Vegas3975 S Durango Dr, Ste 107, Las Vegas, NV 89147ComplianceApr 23, 2027

National Provider Directory

National Provider Directory

Locations

340 Falcon Ridge Pkwy
Ste 404
Mesquite, NV 89027
Phone (702) 346-5510

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 21

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1480291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677801600000",
    "number": "1194268987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9750 W SKYE CANYON PARK DR",
            "address_2": "SUITE 160 BOX103",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "89166",
            "telephone_number": "702-683-1727",
            "fax_number": "702-974-0440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3975 S DURANGO DR STE 107",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891474156",
            "telephone_number": "702-628-5333",
            "fax_number": "702-487-3599"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3975 S Durango Dr Ste 107",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891474156",
            "country_code": "US",
            "telephone_number": "702-628-5333",
            "fax_number": "702-487-3599",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "J H DAULAT DO PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-28",
        "last_updated": "2023-03-03",
        "certification_date": "2023-03-03",
        "deactivation_date": "2021-07-07",
        "reactivation_date": "2021-08-17",
        "status": "A",
        "authorized_official_last_name": "DAULAT",
        "authorized_official_first_name": "JALDEEP",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "702-654-3187",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NV",
            "license": "363",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "MohaveDerm.ema",
            "affiliation": "N",
            "address_1": "3975 S Durango Dr Ste 107",
            "city": "Las Vegas",
            "state": "NV",
            "country_code": "US",
            "postal_code": "891474156",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "MOHAVE DERMATOLOGY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MOHAVE DERMATOLOGY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.