Healthcare Provider Details

I. General information

NPI: 1093942534
Provider Name (Legal Business Name): ANSHU K JAIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2009
Last Update Date: 01/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 SAINT CHRISTOPHER DR
ASHLAND KY
41101-7016
US

IV. Provider business mailing address

122 SAINT CHRISTOPHER DR
ASHLAND KY
41101-7016
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License Number45172
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberL-240344
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: