NPIMap

Organization Active NPI

Ejaz Kamboj, MD, Inc.

  • Cardiovascular Disease Physician
  • Las Vegas, NV
National Provider Identifier
1225254139
Registry record updated Oct 8, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
EJAZ KAMBOJ, MD, INC.
Practice address
1770 N Buffalo Dr Ste 103
Las Vegas, NV 89128-2679
Phone
(702) 650-0009
Fax
(702) 233-5764
NPI assigned
Apr 18, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2018

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

Authorized official

Name
Ejaz U Kamboj, M.D.NPI 1396833810
Title
Owner
Phone
(702) 650-0009

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Cardiovascular Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0000X Primary

Addresses

Primary practice location

1770 N Buffalo Dr Ste 103
Las Vegas, NV 89128-2679

Mailing address

1770 N Buffalo Dr Ste 103
Las Vegas, NV 89128-2679
Phone (702) 650-0009

Other identifiers 1

IdentifierTypeStateIssuer
2018267MedicaidNV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040209000504 NV Part B Supplier - Clinic/Group Practice 3173417516 Receives reassigned benefits from 8 practitioners
Practice locations: Las Vegas, NV

National Provider Directory

National Provider Directory

Locations

3950 S Eastern Ave
Ste 120
Las Vegas, NV 89119
Phone (702) 629-3146

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1538956800000",
    "number": "1225254139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1770 N BUFFALO DR STE 103",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891282679",
            "telephone_number": "702-650-0009",
            "fax_number": "702-233-5764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1770 N BUFFALO DR STE 103",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891282679",
            "telephone_number": "702-650-0009",
            "fax_number": "702-233-5764"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EJAZ KAMBOJ, MD, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-18",
        "last_updated": "2018-10-08",
        "status": "A",
        "authorized_official_last_name": "KAMBOJ",
        "authorized_official_first_name": "EJAZ",
        "authorized_official_middle_name": "U",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "702-650-0009",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2018267",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.