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NPI Code Detail

MEDICARE: JESSE ANG M.D.

MEDICARE: JESSE ANG M.D.
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
1208000000XPediatrics Physician11512NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
111512OTHERNVMEDICAL LICENSE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1891863718
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSE ANG M.D.
Provider Business Mailing Address
First Line : 3325 RESEARCH WAY
Second Line :
City : CARSON CITY
State : NV
Zip : 89706-7913
Country : US
Telephone Number : 775-888-6610
Fax Number : 775-888-4904
Provider Business Practice Location Address
First Line : 2212 S EASTERN AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89104-4124
Country : US
Telephone Number : 702-735-9334
Fax Number : 702-735-9335
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2006
Last Update Date : 01/07/2014

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