Active NPI
Kenya Ruan, CSA
- Surgical Physician Assistant
- Lithonia, GA
National Provider Identifier
1265608269
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- 3136
- Practice address
- 5885 Strathmoor Manor Cir
Lithonia, GA 30058-2620 - Phone
- (404) 402-0053
- NPI assigned
- Apr 30, 2008
- Last updated
- Apr 30, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | 3136 | GA | Primary |
Addresses
Primary practice location
5885 Strathmoor Manor Cir
Lithonia, GA 30058-2620
Mailing address
5885 Strathmoor Manor Cir
Lithonia, GA 30058-2620
Phone (404) 402-0053
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3136 | GA | MD | Surgical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1209513600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1209513600000",
"number": "1265608269",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5885 STRATHMOOR MANOR CIR",
"city": "LITHONIA",
"state": "GA",
"postal_code": "300582620",
"telephone_number": "404-402-0053"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5885 STRATHMOOR MANOR CIR",
"city": "LITHONIA",
"state": "GA",
"postal_code": "300582620",
"telephone_number": "404-402-0053"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUAN",
"first_name": "KENYA",
"credential": "CSA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-04-30",
"last_updated": "2008-04-30",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "GA",
"license": "3136",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lithonia, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.