Provider Demographics
NPI:1568419588
Name:JODHANI, MADHU (MD)
Entity Type:Individual
Prefix:
First Name:MADHU
Middle Name:
Last Name:JODHANI
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:PO BOX 686
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95992-0686
Mailing Address - Country:US
Mailing Address - Phone:530-671-5175
Mailing Address - Fax:530-671-6541
Practice Address - Street 1:481 PLUMAS BLVD
Practice Address - Street 2:102
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-5075
Practice Address - Country:US
Practice Address - Phone:530-671-5175
Practice Address - Fax:530-671-6541
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A504590207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A504590Medicaid
CAF47789Medicare UPIN
CA00A504590Medicare ID - Type Unspecified