Healthcare Provider Details

I. General information

NPI: 1528396967
Provider Name (Legal Business Name): CKJK GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2009
Last Update Date: 10/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1397 GALLERIA DR SUITE 203
HENDERSON NV
89014-6661
US

IV. Provider business mailing address

PO BOX 29502 # 14970
LAS VEGAS NV
89126-9502
US

V. Phone/Fax

Practice location:
  • Phone: 702-476-3400
  • Fax: 702-476-3500
Mailing address:
  • Phone: 702-476-3400
  • Fax: 702-476-3500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number11935
License Number StateNV

VIII. Authorized Official

Name: CAMILLE A. FALKNER
Title or Position: OWNER
Credential: M. D.
Phone: 702-476-3400