Healthcare Provider Details

I. General information

NPI: 1659304392
Provider Name (Legal Business Name): CHEN KUO YOUNG, OD. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 05/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8880 W CHARLESTON BLVD
LAS VEGAS NV
89117-5454
US

IV. Provider business mailing address

8880 W CHARLESTON BLVD
LAS VEGAS NV
89117-5454
US

V. Phone/Fax

Practice location:
  • Phone: 702-938-2020
  • Fax: 702-938-2034
Mailing address:
  • Phone: 702-938-2020
  • Fax: 702-938-2034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number318
License Number StateNV

VIII. Authorized Official

Name: CHEN K YOUNG
Title or Position: OWNER
Credential: O.D.
Phone: 702-938-2020