Provider Demographics
NPI:1588670509
Name:MCCLAIN, JANIS J (MD)
Entity Type:Individual
Prefix:
First Name:JANIS
Middle Name:J
Last Name:MCCLAIN
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 1:4133 VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-4330
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3160 FOLSOM BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5219
Practice Address - Country:US
Practice Address - Phone:916-733-5336
Practice Address - Fax:916-733-5385
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG44769207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000810342691OtherPHCS
CAMCMG170000OtherWESTERN HEALTH ADVANTAGE
CA12570OtherINTERPLAN
CA3737356OtherCIGNA
CA4509119OtherAETNA
CA1062658OtherFIRST HEALTH
CAG44769OtherBLUE CROSS
CA011100OtherHEALTH NET
CA1454467OtherUNITED HEALTHCARE
CA90026465OtherPACIFICARE
CA3737356OtherCIGNA
CA00G447690Medicare ID - Type Unspecified