Provider Demographics
NPI:1669474235
Name:RANK, CHRISTIAN LEE (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:LEE
Last Name:RANK
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 1:7 MARKHAM LN
Mailing Address - Street 2:
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-0904
Mailing Address - Country:US
Mailing Address - Phone:949-630-2887
Mailing Address - Fax:
Practice Address - Street 1:17100 EUCLID ST
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4004
Practice Address - Country:US
Practice Address - Phone:714-966-8105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10935207P00000X
CAA73486207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100504302Medicaid
CA00A734860Medicaid
NV100072Medicare ID - Type UnspecifiedNORIDIAN
CA00A734860Medicaid
CAWA73486DMedicare PIN
NV100504302Medicaid