Provider Demographics
NPI:1114018199
Name:JAN, RONALD G (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:G
Last Name:JAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5025 J ST
Mailing Address - Street 2:SUITE 312
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819
Mailing Address - Country:US
Mailing Address - Phone:916-288-0055
Mailing Address - Fax:916-288-0056
Practice Address - Street 1:5025 J ST
Practice Address - Street 2:SUITE 312
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819
Practice Address - Country:US
Practice Address - Phone:916-288-0055
Practice Address - Fax:916-288-0056
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG2297502086S0129X
CAG229752086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G229750Medicaid
CAG229750Medicare ID - Type UnspecifiedMEDICARE BILLING NUMBER
CA00G229750Medicaid