Provider Demographics
NPI:1528396967
Name:CKJK GROUP LLC
Entity Type:Organization
Organization Name:CKJK GROUP LLC
Other - Org Name:FALKNER GYNECOLOGIC CANCER CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAMILLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:FALKNER
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:702-476-3400
Mailing Address - Street 1:PO BOX 29502
Mailing Address - Street 2:# 14970
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89126-9502
Mailing Address - Country:US
Mailing Address - Phone:702-476-3400
Mailing Address - Fax:702-476-3500
Practice Address - Street 1:1397 GALLERIA DR
Practice Address - Street 2:SUITE 203
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-6661
Practice Address - Country:US
Practice Address - Phone:702-476-3400
Practice Address - Fax:702-476-3500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-23
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11935207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100510111Medicaid
NV100510111Medicaid
NV102891Medicare PIN