Provider Demographics
NPI:1881203073
Name:KOSE ISEH PLLC
Entity Type:Organization
Organization Name:KOSE ISEH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF ENTITY
Authorized Official - Prefix:DR
Authorized Official - First Name:MFON
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:ISEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-768-9291
Mailing Address - Street 1:10470 W CHEYENNE AVENUE
Mailing Address - Street 2:STE 115, PMB 311
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129
Mailing Address - Country:US
Mailing Address - Phone:702-202-4534
Mailing Address - Fax:
Practice Address - Street 1:6166 N DURANGO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-3912
Practice Address - Country:US
Practice Address - Phone:725-223-4100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty