Provider Demographics
NPI:1891006920
Name:LUO, RAN BILL (MD)
Entity Type:Individual
Prefix:DR
First Name:RAN
Middle Name:BILL
Last Name:LUO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:BILL
Other - Middle Name:RAN
Other - Last Name:LUO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:9500 GILMAN DR.
Mailing Address - Street 2:MC 0740
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92093
Mailing Address - Country:US
Mailing Address - Phone:858-534-5107
Mailing Address - Fax:
Practice Address - Street 1:9500 GILMAN DR.
Practice Address - Street 2:MC 0740
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92093
Practice Address - Country:US
Practice Address - Phone:858-534-5107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125-058323208600000X
CAA135777208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
1891006920OtherNPI