Provider Demographics
NPI:1912177247
Name:JANIE KWAK TRAN MD INC
Entity Type:Organization
Organization Name:JANIE KWAK TRAN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KWAK-TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-220-9611
Mailing Address - Street 1:10624 S EASTERN AVE # A285
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2982
Mailing Address - Country:US
Mailing Address - Phone:702-220-9611
Mailing Address - Fax:702-220-9613
Practice Address - Street 1:5052 S JONES BLVD STE 105
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-0552
Practice Address - Country:US
Practice Address - Phone:702-220-9611
Practice Address - Fax:702-220-9613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10236207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002018869Medicaid
NV002018869Medicaid
NV=========OtherCIGNA
NV=========OtherBLUE CROSS BLUE SHIELD
NV=========OtherAETNA
NVV37950Medicare PIN
NV=========OtherTRICARE