Healthcare Provider Details

I. General information

NPI: 1538795836
Provider Name (Legal Business Name): JOHN QIAN M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2020
Last Update Date: 03/18/2020
Certification Date: 03/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5360 JACKSON DR STE 100
LA MESA CA
91942-3012
US

IV. Provider business mailing address

5395 RUFFIN RD STE 204
SAN DIEGO CA
92123-1338
US

V. Phone/Fax

Practice location:
  • Phone: 858-571-3630
  • Fax: 858-430-3146
Mailing address:
  • Phone: 858-571-3630
  • Fax: 858-430-3146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN XIAO-JIANG QIAN
Title or Position: PRESIDENT
Credential: MD
Phone: 858-571-3630