Nina Vandam

Primary specialty

Clinical & Laboratory Dermatological Immunology PhysicianTaxonomy code 207NI0002X

License

G35511 Issued in CA

Practice address

6935 Aliante Parkway
#104-240
North Las Vegas, NV 89084

Phone

(858) 361-9860

NPI assigned

Feb 21, 2024

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Nina Ning Su Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1708473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708473600000",
    "number": "1215793989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6935 ALIANTE PARKWAY",
            "address_2": "#104-240",
            "city": "NORTH LAS VEGAS",
            "state": "NV",
            "postal_code": "89084",
            "telephone_number": "858-361-9860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6935 ALIANTE PARKWAY",
            "address_2": "#104-240",
            "city": "NORTH LAS VEGAS",
            "state": "NV",
            "postal_code": "89084",
            "telephone_number": "858-361-9860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDAM",
        "first_name": "NINA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-02-21",
        "last_updated": "2024-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207NI0002X",
            "taxonomy_group": "",
            "desc": "Dermatology, Clinical & Laboratory Dermatological Immunology",
            "state": "CA",
            "license": "G35511",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NINA",
            "last_name": "SU",
            "middle_name": "NING",
            "credential": "M.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Yolanda Valtierra Gonzalez
• Joyce Van Brakle, RN
• Maria Johanna Van Vianenryder, A.N.P
• Wendy Van Wootten, RD
• Lesley A Vance, D.C.
• Erica A Vandeneynde
• David Michael Vander Veldt, OD
• Anthony Vann
• Daniel David Vanta, RKT
• Melissa Marie Vantuinen, MSN, APRN, FNP-C

• Dermatology Physician in North Las Vegas, NV
• Providers in North Las Vegas, NV by specialty
• Dermatology Physician in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.