Provider Demographics
NPI:1013203082
Name:JAIN, DEEPALI (MD)
Entity Type:Individual
Prefix:DR
First Name:DEEPALI
Middle Name:
Last Name:JAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11511 CANTERWOOD BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-5817
Mailing Address - Country:US
Mailing Address - Phone:253-530-2940
Mailing Address - Fax:360-598-7505
Practice Address - Street 1:11511 CANTERWOOD BLVD STE 140
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98332-5817
Practice Address - Country:US
Practice Address - Phone:253-530-2940
Practice Address - Fax:360-598-7505
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301098632208600000X
WAMD60779039208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2087508Medicaid