1306364914 NPI number — VIP SURG (TSUDA RYAN), PLLC

Table of content: (NPI 1306364914)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306364914 NPI number — VIP SURG (TSUDA RYAN), PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VIP SURG (TSUDA RYAN), PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306364914
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 34270
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89133-4270
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-500-1646
Provider Business Mailing Address Fax Number:
702-487-6006

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
653 N TOWN CENTER DR STE 510
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89144-0519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-448-5578
Provider Business Practice Location Address Fax Number:
702-703-2375
Provider Enumeration Date:
09/03/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TSUDA
Authorized Official First Name:
SHAWN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
702-500-1646

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)