Healthcare Provider Details

I. General information

NPI: 1437558111
Provider Name (Legal Business Name): JOHN M KANE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2014
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4575 W CHARLESTON BLVD STE A
LAS VEGAS NV
89102-1501
US

IV. Provider business mailing address

4575 W CHARLESTON BLVD STE A
LAS VEGAS NV
89102-1501
US

V. Phone/Fax

Practice location:
  • Phone: 702-877-8777
  • Fax:
Mailing address:
  • Phone: 702-877-8777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number17273
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35-128957
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: