Provider Demographics
NPI:1710161518
Name:JIM C CHIANG MD LTD
Entity Type:Organization
Organization Name:JIM C CHIANG MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:C
Authorized Official - Last Name:CHIANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-293-0406
Mailing Address - Street 1:895 ADAMS BLVD
Mailing Address - Street 2:
Mailing Address - City:BOULDER CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89005
Mailing Address - Country:US
Mailing Address - Phone:702-293-0406
Mailing Address - Fax:702-293-0192
Practice Address - Street 1:895 ADAMS BLVD
Practice Address - Street 2:
Practice Address - City:BOULDER CITY
Practice Address - State:NV
Practice Address - Zip Code:89005
Practice Address - Country:US
Practice Address - Phone:702-293-0406
Practice Address - Fax:702-293-0192
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JIM C CHIANG MD LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-28
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11503207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1001507463Medicaid
NV1001507463Medicaid
NVV101680Medicare PIN