Canyon Surgical Specialists LLC

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

Legal business name

CANYON SURGICAL SPECIALISTS LLC

Practice address

6200 N Durango Dr Ste 100
Las Vegas, NV 89149-3939

Phone

(702) 660-5574

NPI assigned

Mar 17, 2023

Organization subpart

No

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

Authorized official

Name

Dr. Jesse Falk, DMDNPI 1285924605

Title

Member

Phone

(702) 660-5574

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NV

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jesse Falk, D.M.D

  • Oral and Maxillofacial Surgery (Dentist)
  • Las Vegas, NV
  • NPI 1285924605
  Medicare reassignment NPD Authorized official
• Harry Hsin-Jong Ching, M.D.

  • Otolaryngology Physician
  • Las Vegas, NV
  • NPI 1720405004
  Medicare reassignment

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

{
    "created_epoch": "1679011200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679011200000",
    "number": "1932801776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6200 N DURANGO DR STE 100",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891493939",
            "telephone_number": "702-660-5574"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6200 N DURANGO DR STE 100",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891493939",
            "telephone_number": "702-660-5574"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANYON SURGICAL SPECIALISTS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-17",
        "last_updated": "2023-03-17",
        "certification_date": "2023-03-17",
        "status": "A",
        "authorized_official_last_name": "FALK",
        "authorized_official_first_name": "JESSE",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "702-660-5574",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Oral & Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Canyon Gate Medical Group, LLC
• Canyon Gate Medical Group, LLC
• Canyon Lake Physical Therapy LLC
• Canyon Light Treatment, LLC
• Canyon Peak Behavioral Health
• Ronetta Canyon
• Jeffrey Koichi Canzani, BCBA, RBT
• Rachael Canzona, MS, MFT-INTERN
• Yordanka Yuliette Cao Izaguirre
• Guorong Cao

• Oral & Maxillofacial Surgery (D.M.D.) in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2023; 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.