1356592802 NPI number — SUNIL K JAIN MD PLLC

Table of content: (NPI 1356592802)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356592802 NPI number — SUNIL K JAIN MD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUNIL K JAIN MD PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356592802
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9878 E ACACIA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85260-2376
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-327-5093
Provider Business Mailing Address Fax Number:
602-251-8895

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
525 N 18TH ST
Provider Second Line Business Practice Location Address:
SUITE 403
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85006-4102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-327-5093
Provider Business Practice Location Address Fax Number:
602-251-8895
Provider Enumeration Date:
10/02/2008

Additional Information

Authorized Official

Authorized Official Last Name:
JAIN
Authorized Official First Name:
SUNIL
Authorized Official Middle Name:
K
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
602-327-5093

Provider Taxonomy Codes

  • Taxonomy code: 2081P2900X , with the licence number:  34116 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 10809160 . This is a "CAQH" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 947864 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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