Healthcare Provider Details

I. General information

NPI: 1942829791
Provider Name (Legal Business Name): JASDAVE S. MAAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2020
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 BELMONT AVE STE 100
MENDOTA CA
93640-8231
US

IV. Provider business mailing address

1660 E HERNDON AVE STE 101
FRESNO CA
93720-3346
US

V. Phone/Fax

Practice location:
  • Phone: 559-424-0160
  • Fax: 559-424-0611
Mailing address:
  • Phone: 559-424-0610
  • Fax: 559-424-0611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA184201
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: