MEDICARE: DR. ALAN K IKEDA MD

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	2080P0207X	Pediatric Hematology & Oncology Physician	A91914	CA
2	2080P0207X	Pediatric Hematology & Oncology Physician	23961	HI
3	2080P0207X	Pediatric Hematology & Oncology Physician	13620	NV
4	208000000X	Pediatrics Physician	A91914	CA
5	208000000X	Pediatrics Physician	13620	NV
6	208000000X	Pediatrics Physician	23961	HI

General Provider Information

NPI Number	:	1154594885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALAN K IKEDA MD

Provider Business Mailing Address
First Line	:	11700 W CHARLESTON BLVD # 170-165
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-1573
Country	:	US
Telephone Number	:	808-852-2487
Fax Number	:

Provider Business Practice Location Address
First Line	:	3087 E WARM SPRINGS RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3753
Country	:	US
Telephone Number	:	702-463-1011
Fax Number	:	702-463-1219

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

Provider Enumeration Date	:	04/02/2008
Last Update Date	:	10/15/2024

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