Healthcare Provider Details

I. General information

NPI: 1144992785
Provider Name (Legal Business Name): STEIN MEDICAL GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2021
Last Update Date: 10/01/2021
Certification Date: 10/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7395 S PECOS RD STE 101
LAS VEGAS NV
89120-3714
US

IV. Provider business mailing address

7204 SHORELINE DR UNIT 160
SAN DIEGO CA
92122-4928
US

V. Phone/Fax

Practice location:
  • Phone: 702-847-6555
  • Fax: 702-847-6428
Mailing address:
  • Phone: 858-774-7287
  • Fax: 702-847-6428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: MIJA SUNG
Title or Position: OFFICE MANAGER/ADMINISTRATOR
Credential:
Phone: 858-774-7287