Provider Demographics
NPI:1912923418
Name:SEVEN HILLS FAMILY PRACTICE LLC
Entity Type:Organization
Organization Name:SEVEN HILLS FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KOCHY
Authorized Official - Middle Name:Y
Authorized Official - Last Name:TANG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:702-837-1265
Mailing Address - Street 1:PO BOX 230181
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89105-0181
Mailing Address - Country:US
Mailing Address - Phone:702-837-1265
Mailing Address - Fax:702-837-1706
Practice Address - Street 1:866 SEVEN HILLS DR STE 102
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4375
Practice Address - Country:US
Practice Address - Phone:702-837-1265
Practice Address - Fax:702-837-1706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV935207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV102613Medicare PIN