Provider Demographics
NPI:1114142494
Name:ISHIBASHI, KIMIKO LYNNE (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMIKO
Middle Name:LYNNE
Last Name:ISHIBASHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3725 LAKESIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509
Mailing Address - Country:US
Mailing Address - Phone:775-737-4707
Mailing Address - Fax:877-548-4385
Practice Address - Street 1:3725 LAKESIDE DRIVE
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509
Practice Address - Country:US
Practice Address - Phone:775-737-4707
Practice Address - Fax:877-548-4385
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12595208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics