Provider Demographics
NPI:1700102464
Name:VISTA FAMILY MEDICINE LLC
Entity Type:Organization
Organization Name:VISTA FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:HYUN
Authorized Official - Middle Name:
Authorized Official - Last Name:HONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-356-8100
Mailing Address - Street 1:4834 SPARKS BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-8215
Mailing Address - Country:US
Mailing Address - Phone:775-356-8100
Mailing Address - Fax:775-356-8101
Practice Address - Street 1:4834 SPARKS BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89436-8215
Practice Address - Country:US
Practice Address - Phone:775-356-8100
Practice Address - Fax:775-356-8101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-20
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9830207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty