Provider Demographics
NPI:1598830416
Name:JIA, RAN (MD)
Entity Type:Individual
Prefix:
First Name:RAN
Middle Name:
Last Name:JIA
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:PO BOX 98978
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-8978
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:100 N GREEN VALLEY PKWY
Practice Address - Street 2:#240
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-6391
Practice Address - Country:US
Practice Address - Phone:702-938-0088
Practice Address - Fax:702-260-4689
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01049735A207P00000X
CAA70416207P00000X
TXK8769207P00000X
NV13443207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1598830416Medicaid
NVV109673Medicare PIN
NVV109672Medicare PIN
PENDINGOtherPTAN
NV1598830416Medicaid
NV1598830416OtherNPI
NVDJ541YMedicare PIN