Healthcare Provider Details

I. General information

NPI: 1447754106
Provider Name (Legal Business Name): DONG YEUNG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 04/29/2022
Certification Date: 04/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3540 W SAHARA AVE # 330
LAS VEGAS NV
89102-5816
US

IV. Provider business mailing address

3540 W SAHARA AVE # 330
LAS VEGAS NV
89102-5816
US

V. Phone/Fax

Practice location:
  • Phone: 702-921-6823
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDO3105
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: