Healthcare Provider Details

I. General information

NPI: 1952672602
Provider Name (Legal Business Name): VIMMI KAUR KANG DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2012
Last Update Date: 01/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10120 S EASTERN AVE
HENDERSON NV
89052-3951
US

IV. Provider business mailing address

10120 S EASTERN AVE
HENDERSON NV
89052-3951
US

V. Phone/Fax

Practice location:
  • Phone: 702-487-6880
  • Fax:
Mailing address:
  • Phone: 702-487-6880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number20A11258
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberDO1720
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number1902
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: