1316903651 NPI number — DR. JAYAPRAKASH NARAYAN YALAMANCHILI MD

Table of content: DR. JAYAPRAKASH NARAYAN YALAMANCHILI MD (NPI 1316903651)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316903651 NPI number — DR. JAYAPRAKASH NARAYAN YALAMANCHILI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YALAMANCHILI
Provider First Name:
JAYAPRAKASH
Provider Middle Name:
NARAYAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
YALAMANCHILI
Provider Other First Name:
JAY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.,
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1316903651
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/25/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6960 SMOKE RANCH RD STE 150
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89128-3204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-384-5101
Provider Business Mailing Address Fax Number:
702-382-5675

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
870 SEVEN HILLS DR STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-384-5101
Provider Business Practice Location Address Fax Number:
702-436-7266
Provider Enumeration Date:
04/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207K00000X , with the licence number:  17597 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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