Individual
DR. BOUNGKHONG DAVID VANSOMPHONE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5375 S FORT APACHE RD, STE# 101, LAS VEGAS, NV 89148-7623
(702) 597-1597
Mailing address
PO BOX 35984, LAS VEGAS, NV 89133-5984
(702) 453-3799
(702) 453-5741
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
9448
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002018399
—
NV
01
—
12431
LIC
MT
01
—
C53921
LIC
CA
01
—
DR48601
LIC
CO
Enumeration date
09/22/2006
Last updated
12/23/2010
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