MEDICARE: VISTA FAMILY MEDICINE 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	207Q00000X	Family Medicine Physician	9830	NV

General Provider Information

NPI Number	:	1700102464
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISTA FAMILY MEDICINE LLC

Provider Business Mailing Address
First Line	:	4834 SPARKS BLVD
Second Line	:	SUITE 100
City	:	SPARKS
State	:	NV
Zip	:	89436-8215
Country	:	US
Telephone Number	:	775-356-8100
Fax Number	:	775-356-8101

Provider Business Practice Location Address
First Line	:	4834 SPARKS BLVD
Second Line	:	SUITE 100
City	:	SPARKS
State	:	NV
Zip	:	89436-8215
Country	:	US
Telephone Number	:	775-356-8100
Fax Number	:	775-356-8101

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	HYUN HONG
Credential	:	MD
Telephone Number	:	775-356-8100

Provider Enumeration Date	:	04/20/2010
Last Update Date	:	08/03/2021

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Directions to “VISTA FAMILY MEDICINE LLC ” Practice Location

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