Healthcare Provider Details

I. General information

NPI: 1952370066
Provider Name (Legal Business Name): KIRTI K JAIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 05/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 SAINT CHRISTOPHER DR
ASHLAND KY
41101
US

IV. Provider business mailing address

122 SAINT CHRISTOPHER DR 122 SAINT CHRISTOPHER DR
ASHLAND KY
41101-7016
US

V. Phone/Fax

Practice location:
  • Phone: 606-836-0202
  • Fax: 606-836-2189
Mailing address:
  • Phone: 606-836-0202
  • Fax: 606-836-2189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number23276
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: