Healthcare Provider Details

I. General information

NPI: 1437682333
Provider Name (Legal Business Name): JASON LAO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6355 S BUFFALO DR FL 3
LAS VEGAS NV
89113-2133
US

IV. Provider business mailing address

6355 S BUFFALO DR FL 3
LAS VEGAS NV
89113-2133
US

V. Phone/Fax

Practice location:
  • Phone: 702-216-3346
  • Fax: 702-671-6883
Mailing address:
  • Phone: 702-216-3346
  • Fax: 702-671-6883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO2802
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: