Healthcare Provider Details

I. General information

NPI: 1477251882
Provider Name (Legal Business Name): RYAN TSIAO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2023
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5320 S RAINBOW BLVD STE 250
LAS VEGAS NV
89118-1807
US

IV. Provider business mailing address

3016 W CHARLESTON BLVD STE 100
LAS VEGAS NV
89102-1973
US

V. Phone/Fax

Practice location:
  • Phone: 702-671-6480
  • Fax: 702-671-6481
Mailing address:
  • Phone: 702-780-2315
  • Fax: 702-895-4014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA3337
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: