MEDICARE: DR. SAMAY JAIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD60771954	WA
2	208800000X	Urology Physician	35099644	OH
3	208800000X	Urology Physician	MD60771954	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	99644	OTHER	OH	LICENSE

General Provider Information

NPI Number	:	1679505515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMAY JAIN M.D.

Provider Business Mailing Address
First Line	:	450 S KITSAP BLVD STE 210
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-3738
Country	:	US
Telephone Number	:	360-895-8950
Fax Number	:	360-830-1385

Provider Business Practice Location Address
First Line	:	450 S KITSAP BLVD STE 210
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-3738
Country	:	US
Telephone Number	:	360-895-8950
Fax Number	:	360-830-1385

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	12/04/2020

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Directions to “ DR. SAMAY JAIN M.D.” Practice Location

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