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General NPI Number Information
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NPI Number | 1063534923
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Entity Type | Organization
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Legal Business Name | LAS VEGAS RADIOLOGY LLC
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7500 SMOKE RANCH RD. STE. 100
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City | LAS VEGAS
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State | NV
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Zip | 89128
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Country | US
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Telephone | 702-254-5004
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Fax | 702-432-4005
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Provider Business Mailing Address
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Address Line | 9811 W CHARLESTON BLVD #2542
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City | LAS VEGAS
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State | NV
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Zip | 89117-7528
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Country | US
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Telephone | 702-254-5004
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Fax | 702-432-4005
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Authorized Official
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Title or Position | PRESIDENT
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Name | PREM K KITTUSAMY
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Credential | M.D.
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Telephone | 702-254-5004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | PENDING
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License Number State | NV
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