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General NPI Number Information
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NPI Number | 1033470364
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Entity Type | Individual
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Provider Name | KYLE GREENE M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/04/2012
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 2300 W CHARLESTON BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89102-2149
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Country | US
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Telephone | 702-724-8787
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Fax |
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Provider Business Mailing Address
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Address Line | 5504 W 138TH PL
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City | HAWTHORNE
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State | CA
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Zip | 90250-6442
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Country | US
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Telephone | 801-628-6213
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A126756
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 28261
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License Number State | NV
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