MEDICARE: LILLIE HIDAJI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	13927	NV

General Provider Information

NPI Number	:	1134381577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILLIE HIDAJI M.D.

Provider Business Mailing Address
First Line	:	8285 W ARBY AVE STE 255
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-2235
Country	:	US
Telephone Number	:	702-476-2944
Fax Number	:	702-852-0331

Provider Business Practice Location Address
First Line	:	8285 W ARBY AVE STE 255
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-2235
Country	:	US
Telephone Number	:	702-476-2944
Fax Number	:	702-852-0331

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2008
Last Update Date	:	04/16/2019

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