Healthcare Provider Details

I. General information

NPI: 1154594885
Provider Name (Legal Business Name): ALAN K IKEDA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2008
Last Update Date: 10/15/2024
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3087 E WARM SPRINGS RD
LAS VEGAS NV
89120-3753
US

IV. Provider business mailing address

11700 W CHARLESTON BLVD # 170-165
LAS VEGAS NV
89135-1573
US

V. Phone/Fax

Practice location:
  • Phone: 702-463-1011
  • Fax: 702-463-1219
Mailing address:
  • Phone: 808-852-2487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberA91914
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number23961
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number13620
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA91914
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number13620
License Number StateNV
# 6
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number23961
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: