Provider Demographics
NPI:1457000192
Name:METABOLIC RESTORATION LLC
Entity Type:Organization
Organization Name:METABOLIC RESTORATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:HAN NAN
Authorized Official - Middle Name:PAIGE
Authorized Official - Last Name:CHONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-340-8729
Mailing Address - Street 1:8879 W FLAMINGO RD STE 102
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-8732
Mailing Address - Country:US
Mailing Address - Phone:702-646-1150
Mailing Address - Fax:702-646-1152
Practice Address - Street 1:8879 W FLAMINGO RD STE 102
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-8732
Practice Address - Country:US
Practice Address - Phone:702-646-1150
Practice Address - Fax:702-646-1152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care