Provider Demographics
NPI:1073284741
Name:MUN, KEON W
Entity Type:Individual
Prefix:
First Name:KEON
Middle Name:W
Last Name:MUN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10220 RARITY AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-2126
Mailing Address - Country:US
Mailing Address - Phone:702-686-0753
Mailing Address - Fax:
Practice Address - Street 1:6351 N FORT APACHE RD # 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-2300
Practice Address - Country:US
Practice Address - Phone:844-545-9342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV20911183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist