Provider Demographics
NPI:1679617914
Name:WESTCLIFF MEDICAL AND DENTAL CENTER
Entity type:Organization
Organization Name:WESTCLIFF MEDICAL AND DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:KWANG
Authorized Official - Middle Name:CHUL
Authorized Official - Last Name:SHIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-363-0232
Mailing Address - Street 1:3150 N TENAYA WAY
Mailing Address - Street 2:690
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0443
Mailing Address - Country:US
Mailing Address - Phone:702-363-0232
Mailing Address - Fax:702-233-3055
Practice Address - Street 1:3150 N TENAYA WAY
Practice Address - Street 2:690
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0443
Practice Address - Country:US
Practice Address - Phone:702-363-0232
Practice Address - Fax:702-233-3055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5895207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty