Healthcare Provider Details

I. General information

NPI: 1407938632
Provider Name (Legal Business Name): VIJAY K JAIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 10/28/2022
Certification Date: 10/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 EAST ST STE 305
CONCORD CA
94520-2066
US

IV. Provider business mailing address

850 W RIO SALADO PKWY STE 201
TEMPE AZ
85281-3812
US

V. Phone/Fax

Practice location:
  • Phone: 925-686-0315
  • Fax: 925-686-8443
Mailing address:
  • Phone: 480-610-6100
  • Fax: 480-610-6183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberC172171
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: