MEDICARE: MR. JAI CHAND AUTAR M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	TP642	KY
2	208000000X	Pediatrics Physician	A99944	CA

General Provider Information

NPI Number	:	1548288491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAI CHAND AUTAR M.D.

Provider Business Mailing Address
First Line	:	780 E WASHINGTON BLVD
Second Line	:	SUITE 202
City	:	CRESCENT CITY
State	:	CA
Zip	:	95531-8397
Country	:	US
Telephone Number	:	707-464-6715
Fax Number	:

Provider Business Practice Location Address
First Line	:	780 E WASHINGTON BLVD
Second Line	:	SUITE 202
City	:	CRESCENT CITY
State	:	CA
Zip	:	95531-8397
Country	:	US
Telephone Number	:	707-464-6715
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	12/13/2021

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