Provider Demographics
NPI:1841487618
Name:YUSON, OLIVIA ONG
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:ONG
Last Name:YUSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 N NELLIS BLVD STE A6
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-5365
Mailing Address - Country:US
Mailing Address - Phone:702-641-3212
Mailing Address - Fax:
Practice Address - Street 1:420 N NELLIS BLVD STE A6
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-5365
Practice Address - Country:US
Practice Address - Phone:702-641-3212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12801208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics