Healthcare Provider Details

I. General information

NPI: 1841826831
Provider Name (Legal Business Name): SUSANNA KAVITA JAIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2020
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 POST ST STE 320
SAN FRANCISCO CA
94115-3466
US

IV. Provider business mailing address

1699 MARKET ST APT 807
SAN FRANCISCO CA
94103-1354
US

V. Phone/Fax

Practice location:
  • Phone: 415-885-7478
  • Fax:
Mailing address:
  • Phone: 916-214-4763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA187687
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: