Healthcare Provider Details

I. General information

NPI: 1629405618
Provider Name (Legal Business Name): DR ADITYA JAIN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2013
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1532 150TH AVE
SAN LEANDRO CA
94578
US

IV. Provider business mailing address

1532 150TH AVE
SAN LEANDRO CA
94578-1823
US

V. Phone/Fax

Practice location:
  • Phone: 510-351-6363
  • Fax: 510-278-3757
Mailing address:
  • Phone: 510-351-6363
  • Fax: 510-278-3757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberA54174
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ADITYA JAIN
Title or Position: CEO
Credential: M.D.
Phone: 510-351-6363