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General NPI Number Information
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NPI Number | 1508219833
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Entity Type | Organization
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Legal Business Name | VEGAS MEDICAL CENTER PLLC
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Dates
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Enumeration Date | 07/21/2016
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Last Update Date | 03/07/2019
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Provider Practice Location Address
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Address Line | 1701 W CHARLESTON BLVD STE 600
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City | LAS VEGAS
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State | NV
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Zip | 89102-2343
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Country | US
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Telephone | 702-763-4585
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Fax | 702-921-9264
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Provider Business Mailing Address
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Address Line | 1701 W CHARLESTON BLVD STE 600
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City | LAS VEGAS
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State | NV
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Zip | 89102-2343
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Country | US
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Telephone | 702-763-4585
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Fax | 702-921-9264
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | QUAN HADUONG
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Credential | MD
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Telephone | 702-763-4585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | B00862
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 7683
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License Number State | NV
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