1558071696 NPI number — UDAY JAIN M D PROFESSIONAL CORPORATION

Table of content: (NPI 1558071696)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558071696 NPI number — UDAY JAIN M D PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UDAY JAIN M D PROFESSIONAL CORPORATION
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:
1558071696
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
505 CHATEAU DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HILLSBOROUGH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94010-6501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-430-0017
Provider Business Mailing Address Fax Number:
650-348-6866

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2222 LAFAYETTE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA CLARA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95050-2904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-988-0105
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/30/2022

Additional Information

Authorized Official

Authorized Official Last Name:
JAIN
Authorized Official First Name:
UDAY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
650-430-0017

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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