Provider Demographics
NPI:1205843877
Name:JAIN, VIVEK (MD)
Entity Type:Individual
Prefix:
First Name:VIVEK
Middle Name:
Last Name:JAIN
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:AMERICAN LAKE DIVISION MAIL STOP: A-116 MHC
Mailing Address - Street 2:9600 VETERANS DRIVE
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98493-0001
Mailing Address - Country:US
Mailing Address - Phone:253-583-1723
Mailing Address - Fax:253-589-4167
Practice Address - Street 1:AMERICAN LAKE DIVISION MAIL STOP: A-116 MHC
Practice Address - Street 2:9600 VETERANS DRIVE
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98493-0001
Practice Address - Country:US
Practice Address - Phone:253-583-1723
Practice Address - Fax:253-589-4167
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS188102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry