Provider Demographics
NPI:1558136960
Name:LAS VEGAS INTEGRATIVE DERMATOLOGY PLLC
Entity Type:Organization
Organization Name:LAS VEGAS INTEGRATIVE DERMATOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:EGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-981-1444
Mailing Address - Street 1:8465 W SAHARA AVE STE 111
Mailing Address - Street 2:PMB 473
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-8902
Mailing Address - Country:US
Mailing Address - Phone:619-981-1444
Mailing Address - Fax:
Practice Address - Street 1:8660 SPRING MOUNTAIN RD STE 101
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-4101
Practice Address - Country:US
Practice Address - Phone:619-981-1444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty