MEDICARE: SG CLINICAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1033073994
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SG CLINICAL

Provider Business Mailing Address
First Line	:	2451 PROFESSIONAL CT STE 110
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0827
Country	:	US
Telephone Number	:	702-409-3770
Fax Number	:	702-240-6545

Provider Business Practice Location Address
First Line	:	2451 PROFESSIONAL CT STE 180
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0827
Country	:	US
Telephone Number	:	702-409-3770
Fax Number	:	702-240-6545

Authorized Official
Title or Position	:	MD
Name	:	SEAN SU
Credential	:	MD
Telephone Number	:	702-338-9500

Provider Enumeration Date	:	12/15/2025
Last Update Date	:	12/15/2025

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1376883652 — MS. KIMBERLY SOPHIA BANNER
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Directions to “SG CLINICAL ” Practice Location

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