Healthcare Provider Details

I. General information

NPI: 1568410272
Provider Name (Legal Business Name): ENDOSCOPIC INSTITUTE OF NEVADA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3777 PECOS MCLEOD SUITE 102
LAS VEGAS NV
89121-4264
US

IV. Provider business mailing address

PO BOX 50652
HENDERSON NV
89016-0652
US

V. Phone/Fax

Practice location:
  • Phone: 702-699-5622
  • Fax: 702-796-5211
Mailing address:
  • Phone: 702-699-5622
  • Fax: 702-796-5211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number471ASC-9
License Number StateNV

VIII. Authorized Official

Name: DR. GREGORY MARTIN KWOK
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 702-699-5622