Provider Demographics
NPI:1982687208
Name:KIP, KATRINKA T (MD)
Entity Type:Individual
Prefix:
First Name:KATRINKA
Middle Name:T
Last Name:KIP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3131 LA CANADA ST STE 230
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-2551
Mailing Address - Country:US
Mailing Address - Phone:702-732-1290
Mailing Address - Fax:702-260-1926
Practice Address - Street 1:85 KIRMAN AVE STE 401
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1360
Practice Address - Country:US
Practice Address - Phone:775-324-6644
Practice Address - Fax:775-322-4748
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV88532080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV7377OtherBLUE CROSS BLUE SHIELD
NVVWCLCQOtherMEDICARE GROUP
XPY191681OtherMEDI-CAL
NV002016475Medicaid
F47327Medicare UPIN
V32823Medicare PIN