Provider Demographics
NPI:1083806517
Name:KIN, ISRAEL M (PA)
Entity Type:Individual
Prefix:MR
First Name:ISRAEL
Middle Name:M
Last Name:KIN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:MR
Other - First Name:ISRAEL
Other - Middle Name:MEIR
Other - Last Name:KIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:8324 LOST PINES CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-7600
Mailing Address - Country:US
Mailing Address - Phone:323-836-1221
Mailing Address - Fax:
Practice Address - Street 1:6900 N PECOS RD
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89086-4400
Practice Address - Country:US
Practice Address - Phone:702-791-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005257363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical