Organization
GERIATRIC MEDICAL ASSOCIATES OF NEVADA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE JEONG DO (OWNER)
(702) 328-3283
Entity
Organization
Contact information
Practice address
9811 W CHARLESTON BLVD, SUITE 2-304, LAS VEGAS, NV 89117-7528
(702) 464-7855
(702) 921-6828
Mailing address
9811 W CHARLESTON BLVD, SUITE 2-304, LAS VEGAS, NV 89117-7528
(702) 464-7855
(702) 921-6828
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
1024
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002018471
—
NV
Enumeration date
10/08/2008
Last updated
02/27/2009
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