Healthcare Provider Details

I. General information

NPI: 1134322464
Provider Name (Legal Business Name): JAMES KUN MAH DDS MSC DMSC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 W CHARLESTON BLVD
LAS VEGAS NV
89102
US

IV. Provider business mailing address

1001 SHADOW LANE A-103
LAS VEGAS NV
89106
US

V. Phone/Fax

Practice location:
  • Phone: 702-774-2816
  • Fax: 702-774-2811
Mailing address:
  • Phone: 702-774-2816
  • Fax: 702-774-2811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number4662T
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: