Provider Demographics
NPI:1497847438
Name:KWAK-TRAN, JANIE (MD)
Entity Type:Individual
Prefix:
First Name:JANIE
Middle Name:
Last Name:KWAK-TRAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10624 S EASTERN AVE # A285
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2982
Mailing Address - Country:US
Mailing Address - Phone:702-220-9611
Mailing Address - Fax:702-220-9163
Practice Address - Street 1:5052 S JONES BLVD STE 105
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-0552
Practice Address - Country:US
Practice Address - Phone:702-220-9611
Practice Address - Fax:702-220-9163
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10236207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV861057211OtherTRICARE
NV861057211OtherCIGNA
NV861057211OtherAETNA
NV002018869Medicaid
NV10236OtherNV STATE LICENSE
NV861057211OtherBCBS
NV861057211OtherTRICARE
NV861057211OtherCIGNA