Healthcare Provider Details

I. General information

NPI: 1801359260
Provider Name (Legal Business Name): NEHA JAIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2019
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 E 31ST ST
OAKLAND CA
94602-1018
US

IV. Provider business mailing address

128 CUESTA DR
LOS ALTOS CA
94022-3941
US

V. Phone/Fax

Practice location:
  • Phone: 510-422-3522
  • Fax: 510-379-7440
Mailing address:
  • Phone: 860-834-5751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA176731
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: