MEDICARE: WAVE ULTRASOUND 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
1	293D00000X	Physiological Laboratory

General Provider Information

NPI Number	:	1902370588
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAVE ULTRASOUND LLC

Provider Business Mailing Address
First Line	:	11132 ZAROD RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-7850
Country	:	US
Telephone Number	:	702-861-8885
Fax Number	:

Provider Business Practice Location Address
First Line	:	8987 W FLAMINGO RD STE 105
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-0437
Country	:	US
Telephone Number	:	702-861-8885
Fax Number	:

Authorized Official
Title or Position	:	USTECH
Name	:	JIHUN KIM
Credential	:
Telephone Number	:	702-861-8885

Provider Enumeration Date	:	01/16/2019
Last Update Date	:	09/16/2025

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