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General NPI Number Information
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NPI Number | 1104547769
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Entity Type | Individual
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Provider Name | WANSEUNG KIM APRN
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Gender | Male
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Dates
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Enumeration Date | 09/12/2022
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Last Update Date | 08/04/2026
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Provider Practice Location Address
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Address Line | 3150 N TENAYA WAY STE 525
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City | LAS VEGAS
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State | NV
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Zip | 89128-0465
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Country | US
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Telephone | 725-204-6520
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Fax |
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Provider Business Mailing Address
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Address Line | 5367 PEACOCK LILY ST
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City | LAS VEGAS
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State | NV
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Zip | 89113-1267
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Country | US
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Telephone | 702-218-0133
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 856178
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN67339
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License Number State | NV
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