Provider Demographics
NPI:1659618189
Name:ARTHUR S TAYENGCO, MD CHARTERED
Entity Type:Organization
Organization Name:ARTHUR S TAYENGCO, MD CHARTERED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:S
Authorized Official - Last Name:TAYENGCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-382-1033
Mailing Address - Street 1:3515 W CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1839
Mailing Address - Country:US
Mailing Address - Phone:702-382-1033
Mailing Address - Fax:702-382-9507
Practice Address - Street 1:3515 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1839
Practice Address - Country:US
Practice Address - Phone:702-382-1033
Practice Address - Fax:702-382-9507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2688261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002002500Medicaid
NVC96632Medicare UPIN