Provider Demographics
NPI:1306861950
Name:KIPPS, THOMAS J (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:KIPPS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3855 HEALTH SCIENCES DR
Mailing Address - Street 2:MAIL CODE 0820
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92093-1503
Mailing Address - Country:US
Mailing Address - Phone:858-534-5400
Mailing Address - Fax:858-534-5620
Practice Address - Street 1:3855 HEALTH SCIENCES DR
Practice Address - Street 2:MAIL CODE 0820
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92093-1503
Practice Address - Country:US
Practice Address - Phone:858-534-5400
Practice Address - Fax:858-534-5620
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG43229207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G432290Medicaid
CAWG43229AMedicare ID - Type Unspecified
CA00G432290Medicaid