Healthcare Provider Details

I. General information

NPI: 1508421371
Provider Name (Legal Business Name): HOA VU CAO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2019
Last Update Date: 07/06/2022
Certification Date: 07/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10624 S EASTERN AVE STE A-955
HENDERSON NV
89052-2982
US

IV. Provider business mailing address

620 SHADOW LN
LAS VEGAS NV
89106-4119
US

V. Phone/Fax

Practice location:
  • Phone: 702-407-7700
  • Fax: 702-407-7016
Mailing address:
  • Phone: 702-388-8000
  • Fax: 702-388-8431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberSL1431
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDO3024
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: