Healthcare Provider Details

I. General information

NPI: 1124535323
Provider Name (Legal Business Name): KENNY ELIAS HANNA MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2018
Last Update Date: 10/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7140 SMOKE RANCH RD STE 150
LAS VEGAS NV
89128-3157
US

IV. Provider business mailing address

7140 SMOKE RANCH RD STE 150
LAS VEGAS NV
89128-3157
US

V. Phone/Fax

Practice location:
  • Phone: 702-320-8111
  • Fax: 702-320-8112
Mailing address:
  • Phone: 702-320-8111
  • Fax: 702-320-8112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number14660
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number14660
License Number StateNV

VIII. Authorized Official

Name: KENNY ELIAS HANNA JR.
Title or Position: PRESIDENT
Credential: MD
Phone: 702-320-8111