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General NPI Number Information
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NPI Number | 1710973839
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Entity Type | Individual
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Provider Name | SANJEEV JAIN M.D.; PHD
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Gender | Male
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Dates
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Enumeration Date | 09/23/2005
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Last Update Date | 11/26/2024
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Provider Practice Location Address
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Address Line | 1152 DOUGLAS ST
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City | LONGVIEW
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State | WA
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Zip | 98632-2452
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Country | US
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Telephone | 360-940-0880
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Fax | 844-697-8702
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Provider Business Mailing Address
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Address Line | 43575 MISSION BLVD #716
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City | FREMONT
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State | CA
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Zip | 94539-5831
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Country | US
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Telephone | 360-609-7077
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Fax | 510-744-9959
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | MD00040042
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | G88329
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | MD162938
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License Number State | OR
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