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NPI Code Detail

MEDICARE: SIMON M GUAN

MEDICARE:   SIMON M GUAN
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
1122300000XDentist7989NV

General Provider Information

NPI Number : 1649962697
Entity Type Code : Individual
Provider Name (Legal Business Name) : SIMON M GUAN
Provider Business Mailing Address
First Line : 6862 CRIMSON LILY ST
Second Line :
City : LAS VEGAS
State : NV
Zip : 89139-7561
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1631 W CRAIG RD STE 10
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89032-0227
Country : US
Telephone Number : 702-649-6644
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2023
Last Update Date : 03/12/2026

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Directions to “ SIMON M GUAN ” Practice Location

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