Provider Demographics
NPI:1528607512
Name:GOOD SAMARITAN LLC
Entity type:Organization
Organization Name:GOOD SAMARITAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:E
Authorized Official - Last Name:JANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-275-3451
Mailing Address - Street 1:3201 S MARYLAND PKWY
Mailing Address - Street 2:TOWER 1 SUITE 314
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-2425
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3201 S MARYLAND PKWY
Practice Address - Street 2:TOWER 1 SUITE 314
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-2425
Practice Address - Country:US
Practice Address - Phone:702-325-9652
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-23
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty