Basic Information
| Provider Information | |||||||||
| NPI: | 1619940103 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TIEN | ||||||||
| FirstName: | MARTIN | ||||||||
| MiddleName: | CHAOYUEH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 15645 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891145645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022427786 | ||||||||
| FaxNumber: | 7022408790 | ||||||||
| Practice Location | |||||||||
| Address1: | 2651 N GREEN VALLEY PKWY | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890140266 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024542666 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2006 | ||||||||
| LastUpdateDate: | 11/22/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 9532 | NV | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3102782 | 05 | NV | MEDICAID | 2018372 | 05 | NV | MEDICAID | VWCHKL | 01 | NV | NORIDIAN | OTHER |