Provider Demographics
NPI:1912780610
Name:HIVELLC
Entity type:Organization
Organization Name:HIVELLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YOUJIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SEO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-954-9534
Mailing Address - Street 1:3080 S NEEDLES HWY STE 1800
Mailing Address - Street 2:
Mailing Address - City:LAUGHLIN
Mailing Address - State:NV
Mailing Address - Zip Code:89029-0894
Mailing Address - Country:US
Mailing Address - Phone:702-709-5300
Mailing Address - Fax:702-709-5303
Practice Address - Street 1:3080 S NEEDLES HWY STE 1800
Practice Address - Street 2:
Practice Address - City:LAUGHLIN
Practice Address - State:NV
Practice Address - Zip Code:89029-0894
Practice Address - Country:US
Practice Address - Phone:702-709-5300
Practice Address - Fax:702-709-5303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-16
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No291U00000XLaboratoriesClinical Medical Laboratory