Provider Demographics
NPI:1407879273
Name:SAXENA, JYOTI (MD)
Entity Type:Individual
Prefix:DR
First Name:JYOTI
Middle Name:
Last Name:SAXENA
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 1:2330 W COVELL BLVD
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-5658
Mailing Address - Country:US
Mailing Address - Phone:530-756-2364
Mailing Address - Fax:
Practice Address - Street 1:2330 W COVELL BLVD
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-5658
Practice Address - Country:US
Practice Address - Phone:530-406-2854
Practice Address - Fax:530-756-5817
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87189207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00745251OtherMEDICARE RAILROAD CARRIER
CA00A871890Medicaid
CA00A871890OtherBLUE SHIELD
CA00A871890Medicaid
H42164Medicare UPIN