Healthcare Provider Details

I. General information

NPI: 1992965156
Provider Name (Legal Business Name): VIKAS JAIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4645 AVON LN STE 340
FRISCO TX
75033-1215
US

IV. Provider business mailing address

4645 AVON LN STE 340
FRISCO TX
75033-1215
US

V. Phone/Fax

Practice location:
  • Phone: 214-308-1525
  • Fax: 855-838-5251
Mailing address:
  • Phone: 214-308-1525
  • Fax: 855-838-5251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number036140333
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License NumberA115489
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License NumberR7027
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberR7027
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number036140333
License Number StateIL
# 6
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License NumberA115489
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: