Healthcare Provider Details

I. General information

NPI: 1053374744
Provider Name (Legal Business Name): RANJIT JAIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 01/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 SHADOW LN 430
LAS VEGAS NV
89106-4126
US

IV. Provider business mailing address

700 SHADOW LN 430
LAS VEGAS NV
89106-4126
US

V. Phone/Fax

Practice location:
  • Phone: 702-384-0500
  • Fax: 702-384-0093
Mailing address:
  • Phone: 702-384-0500
  • Fax: 702-384-0093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number4880
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: