Individual
DR. KENNETH OSITA EDMUNDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6210 N DURANGO DR, LAS VEGAS, NV 89149-3916
(702) 940-1540
(702) 940-1541
Mailing address
6355 S BUFFALO DR FL 3, LAS VEGAS, NV 89113-2133
(702) 216-3346
(702) 671-6883
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
14060
MS
207R00000X
Internal Medicine Physician
Primary
16321
NV
207R00000X
Internal Medicine Physician
26192
TN
207RA0401X
Addiction Medicine (Internal Medicine) Physician
16321
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1265466213
—
NV
01
—
16321
NV STATE LICENSE
NV
Enumeration date
07/10/2006
Last updated
10/18/2022
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