Healthcare Provider Details

I. General information

NPI: 1043498876
Provider Name (Legal Business Name): JOSEPH H. RUAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2008
Last Update Date: 11/30/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9961 SIERRA AVE DEPT OF GENERAL AND PLASTIC SURGERY
FONTANA CA
92335-6720
US

IV. Provider business mailing address

9961 SIERRA AVE DEPT GENERAL AND PLASTIC SURGERY
FONTANA CA
92335-6720
US

V. Phone/Fax

Practice location:
  • Phone: 909-427-5000
  • Fax: 909-427-7060
Mailing address:
  • Phone: 909-427-5000
  • Fax: 909-427-7060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA93995
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: