Provider Demographics
NPI:1093454316
Name:KDMD, LLC
Entity Type:Organization
Organization Name:KDMD, LLC
Other - Org Name:MOUNTAIN VIEW PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:NUSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-228-7054
Mailing Address - Street 1:7010 SMOKE RANCH RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-8399
Mailing Address - Country:US
Mailing Address - Phone:702-228-7054
Mailing Address - Fax:702-381-9418
Practice Address - Street 1:7010 SMOKE RANCH RD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-8399
Practice Address - Country:US
Practice Address - Phone:702-228-7054
Practice Address - Fax:702-381-9418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-03
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty