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General NPI Number Information
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NPI Number | 1023318177
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Entity Type | Organization
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Legal Business Name | MEDICAL ASSOCIATES OF SOUTHERN NEVADA
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Dates
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Enumeration Date | 10/22/2010
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Last Update Date | 10/22/2010
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Provider Practice Location Address
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Address Line | 9975 S EASTERN AVE 110A
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City | LAS VEGAS
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State | NV
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Zip | 89183-7949
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Country | US
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Telephone | 702-492-7208
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Fax | 702-407-5645
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Provider Business Mailing Address
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Address Line | PO BOX 778195
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City | HENDERSON
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State | NV
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Zip | 89077-8195
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Country | US
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Telephone | 702-492-7208
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Fax | 702-407-5645
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GOVIND VENKATA KOKA
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Credential | DO
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Telephone | 702-492-7208
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 1001
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License Number State | NV
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