# KVGP MEDICAL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1841652062
- **Authorized official:** KOBUNA E VICKERS (CEO)
- **Authorized official phone:** (702) 413-3647

## Contact information

- **Practice address:** 3260 FOUNTAIN FALLS WAY, \#2075, NORTH LAS VEGAS, NV 89032-2225
- **Practice address phone:** (702) 413-3647
- **Mailing address:** 3260 FOUNTAIN FALLS WAY, \#2075, NORTH LAS VEGAS, NV 89032-2225
- **Mailing address phone:** (702) 413-3647

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332BX2000X | Oxygen Equipment & Supplies (DME) | — | NULL | Yes |

## Other

- **Enumeration date:** 03/26/2016
- **Last updated:** 03/26/2016