Provider Demographics
NPI:1164512893
Name:PATEL, JAYANTI N (MD)
Entity Type:Individual
Prefix:
First Name:JAYANTI
Middle Name:N
Last Name:PATEL
Suffix:
Gender:M
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:PO BOX 18867
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92817-8867
Mailing Address - Country:US
Mailing Address - Phone:714-404-7602
Mailing Address - Fax:714-974-5580
Practice Address - Street 1:1801 W ROMNEYA DR
Practice Address - Street 2:SUITE 405
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-1826
Practice Address - Country:US
Practice Address - Phone:714-404-7602
Practice Address - Fax:714-974-5580
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA26621207Q00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA26621Medicare UPIN
A26621Medicare UPIN