Provider Demographics
NPI:1851523815
Name:YEKATERINA KHRONUSOVA PC
Entity Type:Organization
Organization Name:YEKATERINA KHRONUSOVA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YEKATERINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHRONUSOVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-898-2084
Mailing Address - Street 1:2165 E WINDMILL LN
Mailing Address - Street 2:SUITE #335
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-2074
Mailing Address - Country:US
Mailing Address - Phone:702-898-2084
Mailing Address - Fax:702-566-6911
Practice Address - Street 1:8420 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-2874
Practice Address - Country:US
Practice Address - Phone:702-898-2084
Practice Address - Fax:702-566-6911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-10
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9662207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV9662OtherNV MEDICAL LICENSE
NVH34543Medicare UPIN