Healthcare Provider Details

I. General information

NPI: 1366645889
Provider Name (Legal Business Name): RJ KOHN FAMILY MEDICINE PROFESSIONAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 11/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5081 N RAINBOW BLVD SUITE 110
LAS VEGAS NV
89130-1626
US

IV. Provider business mailing address

5081 N RAINBOW BLVD SUITE 110
LAS VEGAS NV
89130-1626
US

V. Phone/Fax

Practice location:
  • Phone: 702-487-6500
  • Fax: 702-487-6501
Mailing address:
  • Phone: 702-487-6500
  • Fax: 702-487-6501

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 Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RONALD J KOHN
Title or Position: PRESIDENT
Credential: MD
Phone: 702-487-6500