Healthcare Provider Details

I. General information

NPI: 1164578464
Provider Name (Legal Business Name): KIN YEE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2007
Last Update Date: 04/15/2024
Certification Date: 04/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8440 W LAKE MEAD BLVD STE 111
LAS VEGAS NV
89128-7648
US

IV. Provider business mailing address

3866 TUCKS PT
WINTER PARK FL
32792-6328
US

V. Phone/Fax

Practice location:
  • Phone: 888-854-7672
  • Fax:
Mailing address:
  • Phone: 407-671-3909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberOS-8392
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberDO-2327
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: