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NPI Code Detail

MEDICARE: IMAJ SKIN & WELLNESS CENTER LLC

MEDICARE: IMAJ SKIN & WELLNESS CENTER LLC
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
1207RG0300XGeriatric Medicine (Internal Medicine) Physician
2363LF0000XFamily Nurse Practitioner
3363LP2300XPrimary Care Nurse Practitioner
4207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1194319517
Entity Type Code : Organization
Provider Name (Legal Business Name) : IMAJ SKIN & WELLNESS CENTER LLC
Provider Business Mailing Address
First Line : 10161 PARK RUN DR STE 150
Second Line :
City : LAS VEGAS
State : NV
Zip : 89145-8872
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 10161 PARK RUN DR STE 150
Second Line :
City : LAS VEGAS
State : NV
Zip : 89145-8872
Country : US
Telephone Number : 408-833-3158
Fax Number :
Authorized Official
Title or Position : CEO
Name : CHERRY M LEE
Credential : NP
Telephone Number : 702-782-8941
Provider Enumeration Date : 02/25/2021
Last Update Date : 08/19/2025

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Directions to “IMAJ SKIN & WELLNESS CENTER LLC ” Practice Location

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