Healthcare Provider Details

I. General information

NPI: 1649899691
Provider Name (Legal Business Name): KUNDAN R JANA MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2020
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 JEFFERSON PARK AVE
CHARLOTTESVILLE VA
22903-3363
US

IV. Provider business mailing address

PO BOX 749112
ATLANTA GA
30374-9112
US

V. Phone/Fax

Practice location:
  • Phone: 434-297-4680
  • Fax:
Mailing address:
  • Phone: 434-295-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number0101289156
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: