Healthcare Provider Details

I. General information

NPI: 1306816566
Provider Name (Legal Business Name): JIM C CHIANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

895 ADAMS BLVD
BOULDER CITY NV
89005-2235
US

IV. Provider business mailing address

895 ADAMS BLVD
BOULDER CITY NV
89005-2235
US

V. Phone/Fax

Practice location:
  • Phone: 702-293-0406
  • Fax: 702-293-0192
Mailing address:
  • Phone: 702-293-0406
  • Fax: 702-293-0192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11503
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: