Healthcare Provider Details

I. General information

NPI: 1780190264
Provider Name (Legal Business Name): JUSTIN LIMTONG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2017
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6190 S FORT APACHE RD
LAS VEGAS NV
89148-6702
US

IV. Provider business mailing address

6190 S FORT APACHE RD
LAS VEGAS NV
89148-6702
US

V. Phone/Fax

Practice location:
  • Phone: 702-485-5885
  • Fax: 888-593-7092
Mailing address:
  • Phone: 702-485-5885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberOS18711
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberUO5601
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberDO3399
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: