Healthcare Provider Details

I. General information

NPI: 1811372048
Provider Name (Legal Business Name): MIN-YI HSIAO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2015
Last Update Date: 08/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6127 S RAINBOW BLVD STE 100A
LAS VEGAS NV
89118-3256
US

IV. Provider business mailing address

6127 S RAINBOW BLVD
LAS VEGAS NV
89118-3255
US

V. Phone/Fax

Practice location:
  • Phone: 702-998-2237
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDDS103630
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberS3-332
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: