Healthcare Provider Details

I. General information

NPI: 1033470364
Provider Name (Legal Business Name): KYLE GREENE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2012
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 W CHARLESTON BLVD
LAS VEGAS NV
89102-2149
US

IV. Provider business mailing address

5504 W 138TH PL
HAWTHORNE CA
90250-6442
US

V. Phone/Fax

Practice location:
  • Phone: 702-724-8787
  • Fax:
Mailing address:
  • Phone: 801-628-6213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA126756
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number28261
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: