Healthcare Provider Details

I. General information

NPI: 1942893581
Provider Name (Legal Business Name): JARED KAING PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2021
Last Update Date: 12/27/2025
Certification Date: 12/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5957 W RAMSEY ST
BANNING CA
92220-3058
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 951-845-0313
  • Fax:
Mailing address:
  • Phone: 702-579-3203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number59270
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: