Healthcare Provider Details

I. General information

NPI: 1700602125
Provider Name (Legal Business Name): NAG GI KIM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2024
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2646 W HORIZON RIDGE PKWY STE A-11
HENDERSON NV
89052-2888
US

IV. Provider business mailing address

580 HOWARD AVE
SOMERSET NJ
08873-1113
US

V. Phone/Fax

Practice location:
  • Phone: 702-983-2169
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA-6445
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHAS-4118
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA70033999
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: