Basic Information
| Provider Information | |||||||||
| NPI: | 1598830416 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | JIA | ||||||||
| FirstName: | RAN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 98978 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891938978 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022163346 | ||||||||
| FaxNumber: | 7026716883 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 N GREEN VALLEY PKWY | ||||||||
| Address2: | #240 | ||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890746391 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7029380088 | ||||||||
| FaxNumber: | 7022604689 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2006 | ||||||||
| LastUpdateDate: | 03/26/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 01049735A | IN | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | A70416 | CA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | K8769 | TX | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207R00000X | 13443 | NV | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1598830416 | 05 | NV | MEDICAID |