Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Yudi Wibisono, DO

Individual provider Internal Medicine Physician · NPI 1740711134

Dr. Yudi Wibisono, DO is an Internal Medicine Physician in North las Vegas, Nevada. Works from 3 locations. Licensed in Idaho, Utah and Washington.

Licensed in
ID, UT, WA
In the registry since
2017
Specialties on file
4
What do these letters mean?
DO — Doctor of Osteopathic Medicine
A fully licensed physician, trained like an MD with additional musculoskeletal training. Equivalent practice rights in all 50 states.

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Practice location Address checks out

6900 N Pecos Rd
North las Vegas, NV 89086-4400
Phone: (702) 791-9000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 391 S Chipeta Way Ste C, Salt Lake City, UT 84108-1294 — (801) 581-7224
  • 1400 Pottery Ave, Port Orchard, WA 98366-3711 — (360) 895-5000

Specialties & licences

Occupational Medicine Physician (primary) Taxonomy 2083X0100X · Licence OP61182777 (WA)
Internal Medicine Physician Taxonomy 207R00000X · Licence MRO-1647 (ID)
Preventive Medicine/Occupational Environmental Medicine Physician Taxonomy 2083P0500X · Licence MRO-1647 (ID)
Occupational Medicine Physician Taxonomy 2083X0100X · Licence 10964114-1204 (UT)

Record details

NPI number1740711134
Entity typeIndividual (Type 1)
GenderMale
Credentials DO
Sole proprietorNo
NPI enumeratedMarch 27, 2017
Last updated in NPPESOctober 13, 2022
Certification dateOctober 13, 2022
Mailing address6900 N Pecos Rd, North Las Vegas, NV 89086-4400

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