MEDICARE: GWC DO PC

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	207R00000X	Internal Medicine Physician	DO1669	NV

General Provider Information

NPI Number	:	1871852103
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GWC DO PC

Provider Business Mailing Address
First Line	:	6970 W PATRICK LN
Second Line	:	#140
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-0269
Country	:	US
Telephone Number	:	702-450-1717
Fax Number	:	702-947-6740

Provider Business Practice Location Address
First Line	:	6970 W PATRICK LN
Second Line	:	#140
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-0269
Country	:	US
Telephone Number	:	702-450-1717
Fax Number	:	702-947-6740

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GAR WIN CHUNG
Credential	:	DO
Telephone Number	:	702-450-1717

Provider Enumeration Date	:	05/07/2012
Last Update Date	:	05/07/2012

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