Healthcare Provider Details

I. General information

NPI: 1609321454
Provider Name (Legal Business Name): JAI HO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2016
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 SAND LAKE RD STE 112A
ORLANDO FL
32809-7671
US

IV. Provider business mailing address

1650 SAND LAKE RD SUITE 112A
ORLANDO FL
32809-7681
US

V. Phone/Fax

Practice location:
  • Phone: 407-286-1829
  • Fax: 407-286-3291
Mailing address:
  • Phone: 407-286-1829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License NumberME39710
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KANTILAL BHALANI
Title or Position: PHYSICIA
Credential: MD
Phone: 407-286-1829