Provider Demographics
NPI:1417713579
Name:AMY PATEL JAIN MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:AMY PATEL JAIN MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:PATEL
Authorized Official - Last Name:JAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-273-2362
Mailing Address - Street 1:366 SAN MIGUEL DR STE 206
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7810
Mailing Address - Country:US
Mailing Address - Phone:949-423-9723
Mailing Address - Fax:949-335-6563
Practice Address - Street 1:366 SAN MIGUEL DR STE 206
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7810
Practice Address - Country:US
Practice Address - Phone:949-423-9723
Practice Address - Fax:949-335-6563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty