Active NPI
Khairallah Fayazi, M.D.
- Psychiatry Physician
- Henderson, NV
National Provider Identifier
1528172145
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 11061
- Practice address
- 1090 Wigwam Pkwy
Ste 100
Henderson, NV 89074-8181 - Phone
- (702) 454-0201
- NPI assigned
- Aug 19, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 11061 | NV | Primary |
Addresses
Primary practice location
1090 Wigwam Pkwy
Ste 100
Henderson, NV 89074-8181
Mailing address
1350 Kelso Dunes Ave Apt 321
Henderson, NV 89014-7826
Phone (702) 434-4967
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001700084720 | Medicaid | NV |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11061 | NV | MD | Psychiatry Physician |
| 33059 | AZ | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Vo of Arizona, Inc. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
dba ValueOptions Laboratory Services
- Clinical Medical Laboratory
- Glendale, AZ
- NPI 1447458682
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155945600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1208908800000",
"number": "1528172145",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1350 KELSO DUNES AVE APT 321",
"city": "HENDERSON",
"state": "NV",
"postal_code": "890147826",
"telephone_number": "702-434-4967"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1090 WIGWAM PKWY",
"address_2": "STE 100",
"city": "HENDERSON",
"state": "NV",
"postal_code": "890748181",
"telephone_number": "702-454-0201"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAYAZI",
"first_name": "KHAIRALLAH",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-19",
"last_updated": "2008-04-23",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "NV",
"license": "11061",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "001700084720",
"state": "NV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Henderson, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.