Healthcare Provider Details

I. General information

NPI: 1700960150
Provider Name (Legal Business Name): THOMSON KURIAN CHEMPLAVIL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 01/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8965 S PECOS RD STE 11A
HENDERSON NV
89074-7159
US

IV. Provider business mailing address

8965 S PECOS RD STE 11A
HENDERSON NV
89074
US

V. Phone/Fax

Practice location:
  • Phone: 702-735-4094
  • Fax: 702-735-1994
Mailing address:
  • Phone: 702-735-4094
  • Fax: 702-735-1994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number9370
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number9370
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: