Provider Demographics
NPI:1538232467
Name:JAN, KAI-NING (MD)
Entity type:Individual
Prefix:
First Name:KAI-NING
Middle Name:
Last Name:JAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10769 FLAXTON ST
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-5402
Mailing Address - Country:US
Mailing Address - Phone:310-280-8248
Mailing Address - Fax:
Practice Address - Street 1:6901 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:CUDAHY
Practice Address - State:CA
Practice Address - Zip Code:90201-3646
Practice Address - Country:US
Practice Address - Phone:323-889-7828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64542208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABJ6126999OtherDEA