Provider Demographics
NPI:1982129961
Name:RONALD G. JAN, M.D. INC
Entity Type:Organization
Organization Name:RONALD G. JAN, M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:G
Authorized Official - Last Name:JAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-288-0055
Mailing Address - Street 1:5025 J ST
Mailing Address - Street 2:SUITE #312
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819
Mailing Address - Country:US
Mailing Address - Phone:916-288-0055
Mailing Address - Fax:916-288-0056
Practice Address - Street 1:5025 J ST
Practice Address - Street 2:SUITE #312
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819
Practice Address - Country:US
Practice Address - Phone:916-288-0055
Practice Address - Fax:916-288-0056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-10
Last Update Date:2017-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG229752086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1518429Medicaid