Healthcare Provider Details

I. General information

NPI: 1558749168
Provider Name (Legal Business Name): KITTUSAMY, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2015
Last Update Date: 05/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N BUFFALO DR SUITE 100
LAS VEGAS NV
89145-0310
US

IV. Provider business mailing address

401 N BUFFALO DR SUITE 100
LAS VEGAS NV
89145-0310
US

V. Phone/Fax

Practice location:
  • Phone: 702-853-5681
  • Fax: 702-675-6971
Mailing address:
  • Phone: 702-853-5681
  • Fax: 702-675-6971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PREM KITTUSAMY
Title or Position: OWNER
Credential: MD
Phone: 702-589-2750