Provider Demographics
NPI:1386847648
Name:THAKKER, JAYINI S (MD, DDS)
Entity Type:Individual
Prefix:DR
First Name:JAYINI
Middle Name:S
Last Name:THAKKER
Suffix:
Gender:F
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11092 ANDERSON ST RM 3306
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92350-1706
Mailing Address - Country:US
Mailing Address - Phone:909-558-4671
Mailing Address - Fax:
Practice Address - Street 1:11092 ANDERSON ST RM 3306
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92350-1801
Practice Address - Country:US
Practice Address - Phone:909-558-4671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS59583204E00000X
CAA124009204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery