Provider Demographics
NPI:1134212467
Name:MAHON, KATHLEEN (MD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:
Last Name:MAHON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2598 WINDMILL PKWY
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-5476
Mailing Address - Country:US
Mailing Address - Phone:702-896-6043
Mailing Address - Fax:702-896-9591
Practice Address - Street 1:9100 W POST RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-2418
Practice Address - Country:US
Practice Address - Phone:702-255-6665
Practice Address - Fax:702-255-2994
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV3988207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C96301Medicare UPIN
NVMD3988Medicare ID - Type Unspecified