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NPI Code Detail

MEDICARE: JEDI VENTURES, LLC

MEDICARE: JEDI VENTURES, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QS0132XOphthalmologic Surgery Clinic/CenterCA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1881792596
Entity Type Code : Organization
Provider Name (Legal Business Name) : JEDI VENTURES, LLC
Provider Business Mailing Address
First Line : 3150 J ST
Second Line :
City : SACRAMENTO
State : CA
Zip : 95816-4403
Country : US
Telephone Number : 916-444-7052
Fax Number : 916-446-1145
Provider Business Practice Location Address
First Line : 3150 J ST
Second Line :
City : SACRAMENTO
State : CA
Zip : 95816-4403
Country : US
Telephone Number : 916-444-7052
Fax Number : 916-446-1145
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : DR. KEITH LIANG
Credential : M.D.
Telephone Number : 916-444-7052
Provider Enumeration Date : 09/20/2006
Last Update Date : 01/09/2008

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Directions to “JEDI VENTURES, LLC ” Practice Location

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