MEDICARE: DR. KYLE GREENE M.D.

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	207R00000X	Internal Medicine Physician	A126756	CA
2	207RH0003X	Hematology & Oncology Physician	28261	NV

General Provider Information

NPI Number	:	1033470364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KYLE GREENE M.D.

Provider Business Mailing Address
First Line	:	5504 W 138TH PL
Second Line	:
City	:	HAWTHORNE
State	:	CA
Zip	:	90250-6442
Country	:	US
Telephone Number	:	801-628-6213
Fax Number	:

Provider Business Practice Location Address
First Line	:	2300 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2149
Country	:	US
Telephone Number	:	702-724-8787
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2012
Last Update Date	:	12/12/2025

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Directions to “ DR. KYLE GREENE M.D.” Practice Location

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