Individual
KRIS THANESJESDAPONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8192 SORREL ST, LAS VEGAS, NV 89139-6905
(702) 588-3306
Mailing address
8192 SORREL ST, LAS VEGAS, NV 89139-6905
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2828
NV
Other
Enumeration date
05/23/2022
Last updated
03/27/2024
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