Healthcare Provider Details

I. General information

NPI: 1881657922
Provider Name (Legal Business Name): SIRI L. KJOS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 01/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5320 S. RAINBOW BLVD. STE. 182
LAS VEGAS NV
89118
US

IV. Provider business mailing address

9260 W. SUNSET RD. STE. 200
LAS VEGAS NV
89148-4903
US

V. Phone/Fax

Practice location:
  • Phone: 702-255-3547
  • Fax: 702-921-2419
Mailing address:
  • Phone: 702-255-3547
  • Fax: 702-921-2419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberG51234
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number15288
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: