Provider Demographics
NPI:1558324582
Name:JAIN, KIREN SAVITA (MD)
Entity Type:Individual
Prefix:
First Name:KIREN
Middle Name:SAVITA
Last Name:JAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIREN
Other - Middle Name:SAVITA
Other - Last Name:MEHRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 742244
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-2244
Mailing Address - Country:US
Mailing Address - Phone:408-984-7226
Mailing Address - Fax:
Practice Address - Street 1:2900 WHIPPLE AVENUE
Practice Address - Street 2:SUITE 100
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062
Practice Address - Country:US
Practice Address - Phone:650-261-2303
Practice Address - Fax:650-261-2301
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000397472085R0202X
CAG881602085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1588334582OtherMEDI-CAL
WA8278434Medicaid
WAP00163450OtherRR MEDICARE
OR269553Medicaid
CAAZ150YOtherMEDICARE
ID807275000Medicaid
WA8850159Medicare PIN
CA1588334582OtherMEDI-CAL
WAG47601Medicare UPIN