Provider Demographics
NPI:1861584260
Name:NIP, IVY L (MD)
Entity type:Individual
Prefix:DR
First Name:IVY
Middle Name:L
Last Name:NIP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:IVY
Other - Middle Name:NIP
Other - Last Name:ASANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1380 LUSITANA ST STE 707
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2443
Mailing Address - Country:US
Mailing Address - Phone:808-545-3538
Mailing Address - Fax:808-545-3532
Practice Address - Street 1:1380 LUSITANA ST STE 707
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2443
Practice Address - Country:US
Practice Address - Phone:808-545-3538
Practice Address - Fax:808-545-3532
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD9652207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI08927501Medicaid
HI0000223552OtherHMSA
HI08927501Medicaid
HIG83834Medicare UPIN