Provider Demographics
NPI:1619953056
Name:EGAN, KENDALL M (MD)
Entity Type:Individual
Prefix:DR
First Name:KENDALL
Middle Name:M
Last Name:EGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8465 W SAHARA AVE
Mailing Address - Street 2:SUITE 111 PMB 473
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117
Mailing Address - Country:US
Mailing Address - Phone:
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:702-930-6441
Practice Address - Fax:702-357-4283
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA124554207N00000X
NV20422207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology