Healthcare Provider Details

I. General information

NPI: 1689304123
Provider Name (Legal Business Name): PANG KUO HSU OMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2022
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5594 S FORT APACHE RD STE 110
LAS VEGAS NV
89148-3611
US

IV. Provider business mailing address

5594 S FORT APACHE RD STE 110
LAS VEGAS NV
89148-3611
US

V. Phone/Fax

Practice location:
  • Phone: 702-763-1168
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number2060
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: