Healthcare Provider Details

I. General information

NPI: 1033744305
Provider Name (Legal Business Name): TIMOTHY KATSUHIRO SUGIMOTO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2020
Last Update Date: 11/19/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2845 SIENA HEIGHTS DR
HENDERSON NV
89052-4153
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 702-877-5199
  • Fax: 702-492-9574
Mailing address:
  • Phone: 702-820-3635
  • Fax: 702-804-3626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDO3658
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberDO3658
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: