Provider Demographics
NPI:1275598765
Name:PATEL, JYOTINKUMAR K (MD)
Entity Type:Individual
Prefix:DR
First Name:JYOTINKUMAR
Middle Name:K
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 1:30281 GOLDEN LANTERN
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-5979
Mailing Address - Country:US
Mailing Address - Phone:499-495-7144
Mailing Address - Fax:949-495-0270
Practice Address - Street 1:30281 GOLDEN LANTERN
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-5979
Practice Address - Country:US
Practice Address - Phone:949-495-7144
Practice Address - Fax:949-495-0270
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43752208D00000X, 207Q00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19419OtherGROUP ID
CAE97743Medicare UPIN
CAWA43752DMedicare ID - Type UnspecifiedMEDICARE ID