Provider Demographics
NPI:1073502084
Name:HUANG, KIMBALL YUNG (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBALL
Middle Name:YUNG
Last Name:HUANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 98978
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-8978
Mailing Address - Country:US
Mailing Address - Phone:702-507-2486
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:2650 N TENAYA WAY STE 302
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128
Practice Address - Country:US
Practice Address - Phone:702-240-0088
Practice Address - Fax:702-240-5954
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10267207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1073502084Medicaid
NVFM439ZMedicare PIN
NVFM439Y (CQ328A)Medicare PIN
NVFM439X (CQ328B)Medicare PIN