Basic Information
| Provider Information | |||||||||
| NPI: | 1821112202 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOTHARI | ||||||||
| FirstName: | PRIYA | ||||||||
| MiddleName: | NAYANKUMAR | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1800 W. CHARLESTON BLVD. STE. 508 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023832688 | ||||||||
| FaxNumber: | 7026716595 | ||||||||
| Practice Location | |||||||||
| Address1: | 9320 W. SAHARA AVE. | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023833850 | ||||||||
| FaxNumber: | 7025622816 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2007 | ||||||||
| LastUpdateDate: | 10/01/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 12386 | NV | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | FK0391285 | 01 | NV | DEA | OTHER | WQBHV | 01 | NV | GROUP MEDICARE | OTHER | 100500484 | 01 | NV | GROUP MEDICAID | OTHER | 12386 | 01 | NV | NV LICENSE | OTHER |