MEDICARE: KANGTAI LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1013533512
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KANGTAI LLC

Provider Business Mailing Address
First Line	:	4681 SPRING MOUNTAIN RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-8723
Country	:	US
Telephone Number	:	702-889-8988
Fax Number	:	702-889-9398

Provider Business Practice Location Address
First Line	:	4545 SPRING MOUNTAIN RD STE 111-112
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-8730
Country	:	US
Telephone Number	:	702-463-9988
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	SANDY KANG
Credential	:
Telephone Number	:	702-889-8988

Provider Enumeration Date	:	06/19/2020
Last Update Date	:	06/19/2020

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Directions to “KANGTAI LLC ” Practice Location

Language	Start Address	Practice Location

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