Provider Demographics
NPI:1245412261
Name:JAYA KARNANI MD, PC
Entity Type:Organization
Organization Name:JAYA KARNANI MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KARNANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-691-6622
Mailing Address - Street 1:2382 MARITIME DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-3639
Mailing Address - Country:US
Mailing Address - Phone:916-691-6622
Mailing Address - Fax:916-691-6629
Practice Address - Street 1:2382 MARITIME DR
Practice Address - Street 2:SUITE 100
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-3639
Practice Address - Country:US
Practice Address - Phone:916-691-6622
Practice Address - Fax:916-691-6629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89868261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
I17132Medicare UPIN