NPIMap

Individual provider Active NPI

Kenneth Ejikeme Izuora, MD

  • Endocrinology, Diabetes & Metabolism Physician
  • Las Vegas, NV
National Provider Identifier
1023167525
Registry record updated May 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
13512 Issued in NV
Practice address
1707 W Charleston Blvd Ste 290
Las Vegas, NV 89102-2353
Phone
(702) 671-5070
Fax
(702) 671-5198
NPI assigned
Jan 10, 2007
Last updated
May 28, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 28, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X 061267 GA
Internal Medicine Physician 207R00000X 50418-020 WI
Endocrinology, Diabetes & Metabolism Physician 207RE0101X 13512 NV Primary

Addresses

Primary practice location

1707 W Charleston Blvd Ste 290
Las Vegas, NV 89102-2353

Mailing address

3016 W Charleston Blvd Ste 100
Las Vegas, NV 89102-1973
Phone (702) 780-7118

Other identifiers 1

IdentifierTypeStateIssuer
100500484GROUPMedicaidNV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100907000675 NV Practitioner - EndocrinologyPractitioner - Internal Medicine 6305945643 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
EndocrinologyAlso: Internal Medicine
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Unlv MedicineGroup PAC ID 4183991458, 177 clinicians

Practice addresses (Care Compare)

1707 W Charleston Blvd
Las Vegas, NV 89102-2352

1707 W Charleston Blvd
Las Vegas, NV 89102-2353

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
061267GAMDInternal Medicine Physician
50418-020WIMDInternal Medicine Physician
13512NVMDEndocrinology, Diabetes & Metabolism Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Unlv Medicine CurrentSince Jul 1, 2017 Accepting new patients
Unlv Medicine Internal Medicine CurrentSince Jul 1, 2017 Accepting new patients
Unlv Medicine PastSince May 31, 2020 Accepting new patients
University Medical Center of Southern Nevada Past Accepting new patients
Summerlin Hospital Medical Center L L C Past Accepting new patients

Locations

1524 Pinto Ln
Fl 2
Las Vegas, NV 89106
Phone (702) 671-2236

1707 W Charleston Blvd
Ste 110
Las Vegas, NV 89102
Phone (702) 671-2300

1707 W Charleston Blvd
Ste 230
Las Vegas, NV 89102
Phone (702) 671-5060

1707 W Charleston Blvd
Ste 290
Las Vegas, NV 89102
Phone (702) 671-5139

1800 W Charleston Blvd
Las Vegas, NV 89102
Phone (702) 207-8253

2410 Fire Mesa St
Ste 180
Las Vegas, NV 89128
Phone (702) 202-2700

3016 W Charleston Blvd
Ste 100
Las Vegas, NV 89102
Phone (702) 780-2315

Interoperability endpoints

  • Direct secure messaging: kizuora6223@direct.umcsn.com

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 12

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590624000000",
    "number": "1023167525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3016 W CHARLESTON BLVD STE 100",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891021973",
            "telephone_number": "702-780-7118",
            "fax_number": "702-671-6430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1707 W CHARLESTON BLVD STE 290",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891022353",
            "telephone_number": "702-671-5070",
            "fax_number": "702-671-5198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IZUORA",
        "first_name": "KENNETH",
        "middle_name": "EJIKEME",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-10",
        "last_updated": "2020-05-28",
        "certification_date": "2020-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "061267",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "50418-020",
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "NV",
            "license": "13512",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100500484GROUP",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.