Healthcare Provider Details

I. General information

NPI: 1982129961
Provider Name (Legal Business Name): RONALD G. JAN, M.D. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2017
Last Update Date: 08/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5025 J ST SUITE #312
SACRAMENTO CA
95819
US

IV. Provider business mailing address

5025 J ST SUITE #312
SACRAMENTO CA
95819
US

V. Phone/Fax

Practice location:
  • Phone: 916-288-0055
  • Fax: 916-288-0056
Mailing address:
  • Phone: 916-288-0055
  • Fax: 916-288-0056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberG22975
License Number StateCA

VIII. Authorized Official

Name: DR. RONALD G. JAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 916-288-0055