Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 21161 | NV |
NPI | 1043672090 |
---|---|
Provider Name | Jamie Jiao |
First Address | Las Vegas, NV 89113-2135 |
Second Address | Las Vegas, NV 89113-2135 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2016 |
Last Update Date | 23/07/2021 |