MEDICARE: DR. SISI TIAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207YX0007X	Plastic Surgery within the Head & Neck (Otolaryngology) Physician	17068	NV
2	207Y00000X	Otolaryngology Physician	17068	NV
3	207Y00000X	Otolaryngology Physician	A126477	CA
4	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1447510854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SISI TIAN M.D.

Provider Business Mailing Address
First Line	:	3016 W CHARLESTON BLVD STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1973
Country	:	US
Telephone Number	:	702-780-2315
Fax Number	:	702-895-4014

Provider Business Practice Location Address
First Line	:	5320 S RAINBOW BLVD STE 250
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-1807
Country	:	US
Telephone Number	:	702-671-6480
Fax Number	:	702-671-6481

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2012
Last Update Date	:	10/06/2023

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