Individual provider Active NPI

Dustin Lee Dillon

  • Student in an Organized Health Care Education/Training Program
  • Las Vegas, NV
National Provider Identifier
1083479224
Registry record updated May 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
1707 W Charleston Blvd Ste 160
Las Vegas, NV 89102-2354
Phone
(310) 825-6373
NPI assigned
Feb 16, 2024
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 27, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X LL4316 NV
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

1707 W Charleston Blvd Ste 160
Las Vegas, NV 89102-2354

Mailing address

885 Tiverton Drive
Los Angeles, CA 90095-0001
Phone (310) 825-6373

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240823001375 NV Order and Referring Only - General SurgeryPractitioner - General Surgery 6406395359

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1708041600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748304000000",
    "number": "1083479224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "885 TIVERTON DRIVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900950001",
            "telephone_number": "310-825-6373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1707 W CHARLESTON BLVD STE 160",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891022354",
            "telephone_number": "310-825-6373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DILLON",
        "first_name": "DUSTIN",
        "middle_name": "LEE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-02-16",
        "last_updated": "2025-05-27",
        "certification_date": "2025-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NV",
            "license": "LL4316",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.