Provider Demographics
NPI:1316903651
Name:YALAMANCHILI, JAYAPRAKASH NARAYAN (MD)
Entity type:Individual
Prefix:DR
First Name:JAYAPRAKASH
Middle Name:NARAYAN
Last Name:YALAMANCHILI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JAY
Other - Middle Name:
Other - Last Name:YALAMANCHILI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD,
Mailing Address - Street 1:6960 SMOKE RANCH RD STE 150
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-3204
Mailing Address - Country:US
Mailing Address - Phone:702-384-5101
Mailing Address - Fax:702-382-5675
Practice Address - Street 1:870 SEVEN HILLS DR STE 102
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052
Practice Address - Country:US
Practice Address - Phone:702-384-5101
Practice Address - Fax:702-436-7266
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV17597207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1681911Medicaid
5W864Medicare ID - Type Unspecified
LA1681911Medicaid