Provider Demographics
NPI:1427388925
Name:JAIN, VINAMRA KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:VINAMRA
Middle Name:KUMAR
Last Name:JAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9070 E DESERT COVE AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6227
Mailing Address - Country:US
Mailing Address - Phone:916-891-3001
Mailing Address - Fax:844-842-3418
Practice Address - Street 1:9070 E DESERT COVE AVE STE 102
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6227
Practice Address - Country:US
Practice Address - Phone:480-553-6168
Practice Address - Fax:844-842-3418
Is Sole Proprietor?:No
Enumeration Date:2010-01-05
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ48655207Q00000X, 207Q00000X
KY45281207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ026031OtherMEDICARE
AZ912206Medicaid
KY7100213340Medicaid
AZZ026031OtherMEDICARE
KYK051850Medicare PIN