Provider Demographics
NPI:1902370588
Name:WAVE ULTRASOUND LLC
Entity Type:Organization
Organization Name:WAVE ULTRASOUND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:USTECH
Authorized Official - Prefix:
Authorized Official - First Name:JIHUN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-861-8885
Mailing Address - Street 1:11132 ZAROD RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-7850
Mailing Address - Country:US
Mailing Address - Phone:702-861-8885
Mailing Address - Fax:
Practice Address - Street 1:8987 W FLAMINGO RD STE 105
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-0437
Practice Address - Country:US
Practice Address - Phone:702-861-8885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-16
Last Update Date:2020-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory