Healthcare Provider Details

I. General information

NPI: 1700150885
Provider Name (Legal Business Name): AKSHAT JAIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2012
Last Update Date: 07/30/2020
Certification Date: 07/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1338 E PALM AVE
REDLANDS CA
92374-5433
US

IV. Provider business mailing address

1338 E PALM AVE APT 1
REDLANDS CA
92374-5433
US

V. Phone/Fax

Practice location:
  • Phone: 917-331-3216
  • Fax:
Mailing address:
  • Phone: 917-331-3216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number144710
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: