Provider Demographics
NPI:1306803937
Name:TJIA, VINCENT M (MD)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:M
Last Name:TJIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 W 45TH ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-3014
Mailing Address - Country:US
Mailing Address - Phone:512-320-1500
Mailing Address - Fax:512-459-1399
Practice Address - Street 1:321 W BEN WHITE BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7035
Practice Address - Country:US
Practice Address - Phone:512-320-1500
Practice Address - Fax:512-459-1399
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5587207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164930301Medicaid
TXI06477Medicare UPIN
TX164930301Medicaid
TX8B8789Medicare PIN