Provider Demographics
NPI:1417011511
Name:VOLCHOK, JAPA (DO)
Entity Type:Individual
Prefix:
First Name:JAPA
Middle Name:
Last Name:VOLCHOK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6070 S FORT APACHE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5615
Mailing Address - Country:US
Mailing Address - Phone:702-803-5534
Mailing Address - Fax:888-977-3492
Practice Address - Street 1:6070 S FORT APACHE RD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-5615
Practice Address - Country:US
Practice Address - Phone:702-803-5534
Practice Address - Fax:888-977-3492
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA230726208600000X
NVDO2814208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP00720962OtherRAILROAD MEDICARE
MA001017002Medicare PIN
MA001017001Medicare PIN