MEDICARE: ABBAS R KINGO 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	2080N0001X	Neonatal-Perinatal Medicine Physician	157663	MA

General Provider Information

NPI Number	:	1740237528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABBAS R KINGO M.D.

Provider Business Mailing Address
First Line	:	7331 ELDERLY AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-3223
Country	:	US
Telephone Number	:	702-384-8099
Fax Number	:

Provider Business Practice Location Address
First Line	:	3016 W CHARLESTON BLVD
Second Line	:	#180
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1944
Country	:	US
Telephone Number	:	702-384-8099
Fax Number	:

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

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	07/08/2007

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