Healthcare Provider Details

I. General information

NPI: 1457882680
Provider Name (Legal Business Name): JUSTIN YEUNG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 WHEELER PEAK DR
LAS VEGAS NV
89106-2150
US

IV. Provider business mailing address

1800 W CHARLESTON BLVD
LAS VEGAS NV
89102-2386
US

V. Phone/Fax

Practice location:
  • Phone: 702-383-2565
  • Fax: 702-562-2816
Mailing address:
  • Phone: 702-383-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20223
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: