Healthcare Provider Details

I. General information

NPI: 1023417284
Provider Name (Legal Business Name): MONICA KYUNG-MI GOMEZ RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MONICA K YU

II. Dates (important events)

Enumeration Date: 08/13/2014
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8532 BATTERY CREST LN
WAKE FOREST NC
27587-4123
US

IV. Provider business mailing address

6900 PECOS RD
NORTH LAS VEGAS NV
89086-4400
US

V. Phone/Fax

Practice location:
  • Phone: 725-248-8383
  • Fax:
Mailing address:
  • Phone: 702-791-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number32310DI-0
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: