Healthcare Provider Details

I. General information

NPI: 1770447344
Provider Name (Legal Business Name): YEII KIM
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4580 S EASTERN AVE STE 33
LAS VEGAS NV
89119-6100
US

IV. Provider business mailing address

4580 S EASTERN AVE STE 33
LAS VEGAS NV
89119-6100
US

V. Phone/Fax

Practice location:
  • Phone: 702-882-7828
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: