Individual provider Active NPI

Nana Kobina Kufuor, MD

  • Pediatrics Physician
  • Las Vegas, NV
National Provider Identifier
1750353116
Registry record updated Apr 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
NV9118 Issued in NE
Practice address
4840 E Bonanza St
Suite 5
Las Vegas, NV 89110
Phone
(702) 823-2118
Fax
(702) 823-2339
NPI assigned
Feb 1, 2006
Last updated
Apr 10, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 10, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 9118 NV
Pediatrics Physician 208000000X NV9118 NE Primary

Addresses

Primary practice location

4840 E Bonanza St
Suite 5
Las Vegas, NV 89110

Mailing address

PO Box 371299
Las Vegas, NV 89137
Phone (702) 869-6544

Other practice location 1

653 NTown Center Drive
600
Las Vegas, NV 89144
Phone (702) 869-6544

Other identifiers 2

IdentifierTypeStateIssuer
002018350MedicaidNV
003102350MedicaidNV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
NV9118NEMDPediatrics Physician
9118NVMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pioneer Pediatrics Inc Pediatrics CurrentSince Jan 1, 1990 Accepting new patients
Sunrise Mountainview Hospital, Inc. Past Accepting new patients
Centennial Hills Hospital Medical Center Past Accepting new patients
Summerlin Hospital Medical Center L L C Past Accepting new patients
Sunrise Hospital and Medical Center, LLC Past Accepting new patients

Locations

1040 S Rainbow Blvd
Ste 101
Las Vegas, NV 89145
Phone (702) 203-1715

4840 E Bonanza Rd
Ste 5
Las Vegas, NV 89110
Phone (702) 370-7842

653 N Town Center Dr
Ste 600
Las Vegas, NV 89144
Phone (702) 363-9466

Organizations & group practices 5

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

NPI Registry JSON

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

{
    "created_epoch": "1138752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681084800000",
    "number": "1750353116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 371299",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "89137",
            "telephone_number": "702-869-6544",
            "fax_number": "702-541-7976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4840 E BONANZA ST",
            "address_2": "SUITE 5",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "89110",
            "telephone_number": "702-823-2118",
            "fax_number": "702-823-2339"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "653 NTown Center Drive",
            "address_2": "600",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "89144",
            "country_code": "US",
            "telephone_number": "702-869-6544",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KUFUOR",
        "first_name": "NANA",
        "middle_name": "KOBINA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-01",
        "last_updated": "2023-04-10",
        "certification_date": "2023-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NV",
            "license": "9118",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NE",
            "license": "NV9118",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002018350",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003102350",
            "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 Apr 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.