Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | G22975 | CA |
N | 2086S0129X | Vascular Surgeon | G229750 | CA |
NPI | 1114018199 |
---|---|
Provider Name | Dr. Ronald G Jan |
First Address | Sacramento, CA 95819 |
Second Address | Sacramento, CA 95819 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 28/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G229750 | (02) | CA |
00G229750 | (05) | CA |