Healthcare Provider Details

I. General information

NPI: 1821658485
Provider Name (Legal Business Name): JING SUN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2019
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7455 W WASHINGTON AVE STE 301
LAS VEGAS NV
89128-4340
US

IV. Provider business mailing address

1355 RIVER BEND DR
DALLAS TX
75247-4915
US

V. Phone/Fax

Practice location:
  • Phone: 702-732-3441
  • Fax: 702-938-9954
Mailing address:
  • Phone: 214-237-1818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberDO3692
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: