Provider Demographics
NPI:1639231954
Name:RESTORATIVE MEDICINE LLC
Entity Type:Organization
Organization Name:RESTORATIVE MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MINH
Authorized Official - Middle Name:H
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-407-8241
Mailing Address - Street 1:PO BOX 98820
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-8820
Mailing Address - Country:US
Mailing Address - Phone:702-407-8241
Mailing Address - Fax:702-492-1728
Practice Address - Street 1:6955 N DURANGO DR
Practice Address - Street 2:SUITE 1115-361
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-4411
Practice Address - Country:US
Practice Address - Phone:702-407-8241
Practice Address - Fax:702-492-1728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV103552081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV103539Medicare PIN
NVH80682Medicare UPIN
NVH80682Medicare UPIN