Healthcare Provider Details

I. General information

NPI: 1750132189
Provider Name (Legal Business Name): KENJY ANTHONY WUN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 N LAMB BLVD STE 130
LAS VEGAS NV
89110-6355
US

IV. Provider business mailing address

922 DAWN VALLEY DR
NORTH LAS VEGAS NV
89031-6608
US

V. Phone/Fax

Practice location:
  • Phone: 702-331-0100
  • Fax:
Mailing address:
  • Phone: 702-544-8328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: