Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 5101021664 | MI |
N | 111NI0900X | Internist | 5101021664 | MI |
Y | 207RC0000X | Internist - Cardiovascular Disease | DO2923 | NV |
NPI | 1023496957 |
---|---|
Provider Name | Randy James Ip |
First Address | Las Vegas, NV 89193-8978 |
Second Address | Henderson, NV 89052-4171 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2015 |
Last Update Date | 12/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DO2923 | STATE LICENSE (01) | NV |