1053374744 NPI number — RANJIT JAIN M.D.

Table of content: RANJIT JAIN M.D. (NPI 1053374744)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053374744 NPI number — RANJIT JAIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JAIN
Provider First Name:
RANJIT
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053374744
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/31/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 SHADOW LN
Provider Second Line Business Mailing Address:
430
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89106-4126
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-384-0500
Provider Business Mailing Address Fax Number:
702-384-0093

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 SHADOW LN
Provider Second Line Business Practice Location Address:
430
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89106-4126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-384-0500
Provider Business Practice Location Address Fax Number:
702-384-0093
Provider Enumeration Date:
04/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  4880 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2002903 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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