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General NPI Number Information
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NPI Number | 1992899041
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Entity Type | Individual
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Provider Name | JAYANTA KUMAR PAL MD
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Gender | Male
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 01/19/2025
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Provider Practice Location Address
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Address Line | 16756 CHINO CORONA RD
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City | CORONA
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State | CA
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Zip | 92880-9508
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Country | US
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Telephone | 732-823-2941
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Fax |
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Provider Business Mailing Address
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Address Line | 26284 PASEO SILLIN
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-5004
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Country | US
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Telephone | 732-823-2941
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Fax |
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 25MA07649700
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | C158290
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License Number State | CA
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