Healthcare Provider Details

I. General information

NPI: 1013533512
Provider Name (Legal Business Name): KANGTAI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2020
Last Update Date: 06/19/2020
Certification Date: 06/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4545 SPRING MOUNTAIN RD STE 111-112
LAS VEGAS NV
89102-8730
US

IV. Provider business mailing address

4681 SPRING MOUNTAIN RD
LAS VEGAS NV
89102-8723
US

V. Phone/Fax

Practice location:
  • Phone: 702-463-9988
  • Fax:
Mailing address:
  • Phone: 702-889-8988
  • Fax: 702-889-9398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SANDY KANG
Title or Position: ADMINISTRATOR
Credential:
Phone: 702-889-8988