Provider Demographics
NPI:1477853489
Name:SIM, KALANN MARKEY
Entity Type:Individual
Prefix:MR
First Name:KALANN
Middle Name:MARKEY
Last Name:SIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 NORTH MARTIN LUTHER KING BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:N. LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032
Mailing Address - Country:US
Mailing Address - Phone:702-522-7800
Mailing Address - Fax:702-974-1264
Practice Address - Street 1:4100 NORTH MARTIN LUTHER KING BLVD
Practice Address - Street 2:STE 100
Practice Address - City:N. LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032
Practice Address - Country:US
Practice Address - Phone:702-522-7800
Practice Address - Fax:702-974-1264
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker