Healthcare Provider Details

I. General information

NPI: 1356683049
Provider Name (Legal Business Name): DAVID G KUYKENDALL M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2013
Last Update Date: 05/22/2020
Certification Date: 05/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 PINTO LN FL 2
LAS VEGAS NV
89106-4195
US

IV. Provider business mailing address

1701 W. CHARLESTON BLVD. SUITE 670 ATTN. SANDRA EROSA
LAS VEGAS NV
89102
US

V. Phone/Fax

Practice location:
  • Phone: 702-992-6888
  • Fax: 702-992-6880
Mailing address:
  • Phone: 702-671-2355
  • Fax: 702-382-5388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code193200000X
TaxonomyMulti-Specialty Group
License Number16524
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number16524
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: