Provider Demographics
NPI:1285629840
Name:JAIN, VIJAY K (PSYD)
Entity Type:Individual
Prefix:DR
First Name:VIJAY
Middle Name:K
Last Name:JAIN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15615 NORTH 71ST STREET
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254
Mailing Address - Country:US
Mailing Address - Phone:602-494-8105
Mailing Address - Fax:602-494-8108
Practice Address - Street 1:15615 NORTH 71ST STREET
Practice Address - Street 2:SUITE 108
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254
Practice Address - Country:US
Practice Address - Phone:602-494-8105
Practice Address - Fax:602-494-8108
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3009103TC0700X
HI524103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
68471Medicare ID - Type Unspecified
C68470Medicare UPIN