Healthcare Provider Details

I. General information

NPI: 1063184935
Provider Name (Legal Business Name): MRS. MIKI TON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2021
Last Update Date: 09/29/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3885 S DECATUR BLVD STE 2000A
LAS VEGAS NV
89103-5873
US

IV. Provider business mailing address

3885 S DECATUR BLVD STE 2000A
LAS VEGAS NV
89103-5873
US

V. Phone/Fax

Practice location:
  • Phone: 702-613-8842
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberNV20212230488
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: