MEDICARE: NIPAPHAN YINGYOUD OMD

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	225700000X	Massage Therapist	5862	NV
2	171100000X	Acupuncturist	NV.2069	NV

General Provider Information

NPI Number	:	1134800014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIPAPHAN YINGYOUD OMD

Provider Business Mailing Address
First Line	:	9640 W TROPICANA AVE STE 115
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-2604
Country	:	US
Telephone Number	:	888-582-7600
Fax Number	:

Provider Business Practice Location Address
First Line	:	9640 W TROPICANA AVE STE 115
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-2604
Country	:	US
Telephone Number	:	888-582-7600
Fax Number	:

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

Provider Enumeration Date	:	07/25/2023
Last Update Date	:	07/27/2023

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