MEDICARE: SIMON M GUAN

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	122300000X	Dentist	7989	NV

General Provider Information

NPI Number	:	1649962697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIMON M GUAN

Provider Business Mailing Address
First Line	:	1631 W CRAIG RD STE 10
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-0227
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1631 W CRAIG RD STE 10
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-0227
Country	:	US
Telephone Number	:	702-649-6644
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2023
Last Update Date	:	03/19/2026

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Directions to “ SIMON M GUAN ” Practice Location

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