MEDICARE: WT HEALTH OF NEVADA 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	207RI0200X	Infectious Disease Physician

General Provider Information

NPI Number	:	1639961931
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WT HEALTH OF NEVADA LLC

Provider Business Mailing Address
First Line	:	PO BOX 848411
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90084-8411
Country	:	US
Telephone Number	:	954-923-7440
Fax Number	:	954-923-1299

Provider Business Practice Location Address
First Line	:	2621 W HORIZON RIDGE PKWY STE 110
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-2895
Country	:	US
Telephone Number	:	954-923-7440
Fax Number	:	954-923-1299

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	MINGHSUN LIU
Credential	:	MD
Telephone Number	:	310-734-8526

Provider Enumeration Date	:	05/21/2025
Last Update Date	:	12/16/2025

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