Healthcare Provider Details

I. General information

NPI: 1114238540
Provider Name (Legal Business Name): DAVID BYUN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2010
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 AVENUE H
ELY NV
89301
US

IV. Provider business mailing address

1500 AVENUE H
ELY NV
89301-2615
US

V. Phone/Fax

Practice location:
  • Phone: 775-289-3612
  • Fax: 775-289-6423
Mailing address:
  • Phone: 775-289-3001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number006345
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberDO1835
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDO1835
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: