MEDICARE: RYAN HUANG D.O.

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	208600000X	Surgery Physician	DO2404	NV
2	207Q00000X	Family Medicine Physician	SL1161	NV
3	207Q00000X	Family Medicine Physician	DO2404	NV

General Provider Information

NPI Number	:	1871942151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN HUANG D.O.

Provider Business Mailing Address
First Line	:	3750 S JONES BLVD
Second Line	:	STE 120
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-2209
Country	:	US
Telephone Number	:	702-434-8880
Fax Number	:	702-862-8880

Provider Business Practice Location Address
First Line	:	2995 S JONES BLVD STE A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5612
Country	:	US
Telephone Number	:	702-805-1880
Fax Number	:	702-805-1880

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

Provider Enumeration Date	:	06/08/2016
Last Update Date	:	08/09/2019

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Directions to “ RYAN HUANG D.O.” Practice Location

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