Organization
K.F.B.H., LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KHAIRALLAH FAYAZI M.D. (MANAGING MEMBER)
(602) 327-5747
Entity
Organization
Contact information
Practice address
1090 WIGWAM PKWY, SUITE 100, HENDERSON, NV 89074
(702) 454-0201
Mailing address
1350 KELSO DUNES AVE, APT. 321, HENDERSON, NV 89014-7816
(702) 485-6612
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
11061
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001700084720
—
NV
Enumeration date
07/11/2007
Last updated
04/23/2008
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