Provider Demographics
NPI:1821039546
Name:JIANU, TUDOR C (MD)
Entity Type:Individual
Prefix:
First Name:TUDOR
Middle Name:C
Last Name:JIANU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8420 S EASTERN AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-2875
Mailing Address - Country:US
Mailing Address - Phone:702-385-6468
Mailing Address - Fax:702-385-2663
Practice Address - Street 1:8420 S EASTERN AVE STE 101
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-2875
Practice Address - Country:US
Practice Address - Phone:702-385-6468
Practice Address - Fax:702-385-2663
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8309207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVG49300Medicare UPIN
NV100269Medicare ID - Type Unspecified