1639483746 NPI number — MELINDA KWAN DO

Table of content: MELINDA KWAN DO (NPI 1639483746)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639483746 NPI number — MELINDA KWAN DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KWAN
Provider First Name:
MELINDA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639483746
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 35380
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:
89133-5380
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-838-8265
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2845 SIENA HEIGHTS DR STE 1100
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:
89052-4161
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-669-5840
Provider Business Practice Location Address Fax Number:
702-650-5729
Provider Enumeration Date:
07/30/2010

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: 207Q00000X , with the licence number:  DO1809 , 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)

  • Identifier: 1639483746 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01386897 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: 1639483746 . This is a "MEDICAID SMA CONVENIENT CARE" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: V106802 . This is a "MEDICARE SMACC" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".




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