Healthcare Provider Details

I. General information

NPI: 1235352394
Provider Name (Legal Business Name): BRIAN KUNG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 09/22/2023
Certification Date: 09/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3692 E SUNSET RD
LAS VEGAS NV
89120-7237
US

IV. Provider business mailing address

11035 LAVENDER HILL DR # 160-589
LAS VEGAS NV
89135-2955
US

V. Phone/Fax

Practice location:
  • Phone: 702-735-7668
  • Fax: 702-735-1411
Mailing address:
  • Phone: 267-515-4199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberC1-0007869
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License NumberA103146
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number60913455
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number21963
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: