Healthcare Provider Details

I. General information

NPI: 1013658723
Provider Name (Legal Business Name): ASIAN COMMUNITY DEVELOPMENT COUNCIL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 04/05/2022
Certification Date: 04/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8863 W FLAMINGO RD
LAS VEGAS NV
89147-8759
US

IV. Provider business mailing address

1027 S RAINBOW BLVD STE 253
LAS VEGAS NV
89145-6232
US

V. Phone/Fax

Practice location:
  • Phone: 702-000-0000
  • Fax: 702-000-0000
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE LIN
Title or Position: CLINICAL DIRECTOR
Credential: DO
Phone: 702-000-0000