Taylor Raeanne Fong, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA2787 Issued in NV

Practice address

1 Breakthrough Way
Las Vegas, NV 89135-3011

Phone

(702) 732-1493

Fax

(702) 732-1080

NPI assigned

Oct 5, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Alliance for Childhood Diseases

  • Pediatric Hematology & Oncology Physician
  • Las Vegas, NV
  • NPI 1013292689
  Medicare reassignment NPD
• Summerlin Hospital Medical Center L L C

  • General Acute Care Hospital
  • Las Vegas, NV
  • NPI 1831189638
  NPD (past)

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

{
    "created_epoch": "1664928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678924800000",
    "number": "1689399289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10170 W TROPICANA AVE # 156-252",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891478465",
            "telephone_number": "702-732-1493",
            "fax_number": "702-732-1080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 BREAKTHROUGH WAY",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891353011",
            "telephone_number": "702-732-1493",
            "fax_number": "702-732-1080"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4425 S Pecos Rd Ste 6",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891215037",
            "country_code": "US",
            "telephone_number": "702-333-7000",
            "fax_number": "702-732-1493",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FONG",
        "first_name": "TAYLOR",
        "middle_name": "RAEANNE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-10-05",
        "last_updated": "2023-03-16",
        "certification_date": "2023-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NV",
            "license": "PA2787",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Henley Herbert Fong
• Johnny Fong, MD
• Michelle Fong
• Natividad Fong
• Ryan Fong, DMD
• Victor Fong, M.D.
• Jennifer Fonseca Avila
• Martina Fonseca Castaneda
• Aida Ester Fonseca Chibas
• Demi Fonseca

• Physician Assistant in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Physician Assistant in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.