DR. ILYA YEGUDKIN DO
NPI 1750066593
Student in an Organized Health Care Education/Training Program in Las Vegas, NV

Active since June 20, 2023PECOS Enrolled
620 SHADOW LN, LAS VEGAS, NV 89106(702) 388-4000 Get Directions Write a Review

NPPES record last updated: November 21, 2025. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Nov 21, 2025, Jun 20, 2023 (2 updates tracked since 2023).

About Dr. Ilya Yegudkin Do NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. ILYA YEGUDKIN DO (NPI 1750066593) is an individual student in an organized health care education/training program in Las Vegas, Nevada, licensed in Nevada (SL2023) and active in the NPI registry since June 2023. He is enrolled in Medicare PECOS and is a graduate of Touro Un Col Of Osteopathic Medicine, Henderson (2023).

NPPES Registry Identity

NPI1750066593
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameDR. ILYA YEGUDKINCredential: DO
Location Address620 SHADOW LNLas Vegas, NV 89106-4194
Mailing Address620 Shadow LnLas Vegas, NV 89106-4194 · (702) 388-4000
Sole ProprietorNo
Medical School CMSTouro Un Col Of Osteopathic Medicine, HendersonGraduated 2023
Enumeration DateJune 20, 2023
Last NPPES UpdateNovember 21, 20252 updates tracked since enumeration
NPPES CertifiedNovember 21, 2025
NPI 1750066593 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

Taxonomy Code390200000X
License Licensed in NV · SL2023
Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

Also ListedGeneral PracticeTaxonomy 208D00000X · License DO3957 (NV)
620 SHADOW LN, Las Vegas, NV 89106

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare (PECOS)

Dr. Ilya Yegudkin Do is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID3678929452
PECOS Enrollment IDI20260129001868
Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Pediatrics (Neonatal-Perinatal Medicine)
620 SHADOW LN, VALLEY HOSPITAL
LAS VEGAS, NV 89106
Nurse Practitioner (Neonatal)
620 SHADOW LN
LAS VEGAS, NV 89106
Specialist
620 SHADOW LN
LAS VEGAS, NV 89106
Emergency Medicine
620 SHADOW LN
LAS VEGAS, NV 89106
Emergency Medicine
620 SHADOW LN
LAS VEGAS, NV 89106
Emergency Medicine
620 SHADOW LN
LAS VEGAS, NV 89106
Emergency Medicine
620 SHADOW LN
LAS VEGAS, NV 89106
Emergency Medicine
620 SHADOW LN
LAS VEGAS, NV 89106

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1750066593, enumerated as an "individual" on June 20, 2023.

The provider is located at 620 SHADOW LN LAS VEGAS, NV 89106 and the phone number is (702) 388-4000.

Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.