Healthcare Provider Details

I. General information

NPI: 1700457546
Provider Name (Legal Business Name): VINAYAK JAIN MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MR. ROHIT JAIN

II. Dates (important events)

Enumeration Date: 07/02/2021
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date: 04/03/2023
Reactivation Date: 04/11/2023

III. Provider practice location address

DEPT OF PULMONARY & CRITICAL CARE 800 STANTON L YOUNG BLVD
OKLAHOMA CITY OK
73117
US

IV. Provider business mailing address

DEPT OF PULMONARY & CRITICAL CARE 800 STANTON L YOUNG BLVD
OKLAHOMA CITY OK
73117
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-6173
  • Fax:
Mailing address:
  • Phone: 405-271-6173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number43118
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number43118
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: