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General NPI Number Information
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NPI Number | 1558136960
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Entity Type | Organization
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Legal Business Name | LAS VEGAS INTEGRATIVE DERMATOLOGY PLLC
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Dates
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Enumeration Date | 11/16/2023
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Last Update Date | 11/16/2023
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Provider Practice Location Address
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Address Line | 8660 SPRING MOUNTAIN RD STE 101
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City | LAS VEGAS
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State | NV
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Zip | 89117-4101
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Country | US
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Telephone | 619-981-1444
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Fax |
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Provider Business Mailing Address
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Address Line | 8465 W SAHARA AVE STE 111 PMB 473
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City | LAS VEGAS
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State | NV
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Zip | 89117-8902
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Country | US
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Telephone | 619-981-1444
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KENDALL EGAN
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Credential | MD
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Telephone | 619-981-1444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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