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General NPI Number Information
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NPI Number | 1558749168
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Entity Type | Organization
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Legal Business Name | KITTUSAMY, LLP
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Dates
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Enumeration Date | 05/14/2015
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Last Update Date | 05/14/2015
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Provider Practice Location Address
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Address Line | 401 N BUFFALO DR SUITE 100
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City | LAS VEGAS
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State | NV
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Zip | 89145-0310
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Country | US
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Telephone | 702-853-5681
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Fax | 702-675-6971
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Provider Business Mailing Address
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Address Line | 401 N BUFFALO DR SUITE 100
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City | LAS VEGAS
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State | NV
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Zip | 89145-0310
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Country | US
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Telephone | 702-853-5681
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Fax | 702-675-6971
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Authorized Official
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Title or Position | OWNER
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Name | PREM KITTUSAMY
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Credential | MD
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Telephone | 702-589-2750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QB0002X
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Taxonomy Name | Obesity Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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