Basic Information
| Provider Information | |||||||||
| NPI: | 1164546719 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SINGH | ||||||||
| FirstName: | RAJ | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 500 S RANCHO DR | ||||||||
| Address2: | SUITE 12 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891064844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7028771887 | ||||||||
| FaxNumber: | 7028774536 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 S RANCHO DR | ||||||||
| Address2: | SUITE 12 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891064844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7028771887 | ||||||||
| FaxNumber: | 7028774536 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2007 | ||||||||
| LastUpdateDate: | 05/11/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 05/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | 12939 | NV | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207R00000X | A 104464 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | LL1562 | 01 | NV | MEDICAL LICENSE | OTHER | 12939 | 01 | NV | MEDICAL LICENSE | OTHER | 7089 | 01 | KS | MEDICAL LICENSE | OTHER | A 104464 | 01 | CA | MEDICAL LICENSE | OTHER | 0433717 | 01 | KS | STATE MEDICAL LICENSE | OTHER | ASO2532189119 | 01 | NV | DEA CERTIFICATE | OTHER | FD 0917421 | 01 | KS | DEA | OTHER |