Provider Demographics
NPI:1275791881
Name:JAIN, PRIYANKA (MD)
Entity Type:Individual
Prefix:
First Name:PRIYANKA
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 1:1100 OLIVEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-1210
Mailing Address - Country:US
Mailing Address - Phone:209-325-4149
Mailing Address - Fax:209-720-0211
Practice Address - Street 1:1100 OLIVEWOOD DR
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-1210
Practice Address - Country:US
Practice Address - Phone:209-325-4149
Practice Address - Fax:209-720-0211
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.206872207W00000X
CAC161938207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology