Healthcare Provider Details

I. General information

NPI: 1780889063
Provider Name (Legal Business Name): HAINES K PAIK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 08/16/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2779 W HORIZON RIDGE PKWY STE 200
HENDERSON NV
89052-4186
US

IV. Provider business mailing address

2779 W HORIZON RIDGE PKWY STE 200
HENDERSON NV
89052-4186
US

V. Phone/Fax

Practice location:
  • Phone: 702-990-2290
  • Fax: 702-990-2297
Mailing address:
  • Phone: 702-990-2290
  • Fax: 702-990-2297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number250504
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: