Healthcare Provider Details

I. General information

NPI: 1336235506
Provider Name (Legal Business Name): SCOTT E. JENKINS M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 SUPERIOR AVE STE 310
NEWPORT BEACH CA
92663-3641
US

IV. Provider business mailing address

PO BOX 306
SUISUN CITY CA
94585-0306
US

V. Phone/Fax

Practice location:
  • Phone: 949-574-9300
  • Fax: 949-548-4544
Mailing address:
  • Phone: 657-241-3600
  • Fax: 657-241-7708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. SCOTT E JENKINS
Title or Position: OWNER
Credential: MD
Phone: 949-574-9300