Provider Demographics
NPI:1609321454
Name:JAI HO
Entity Type:Organization
Organization Name:JAI HO
Other - Org Name:SAND LAKE MEDICAL WALK IN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIA
Authorized Official - Prefix:
Authorized Official - First Name:KANTILAL
Authorized Official - Middle Name:
Authorized Official - Last Name:BHALANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-286-1829
Mailing Address - Street 1:1650 SAND LAKE RD
Mailing Address - Street 2:SUITE 112A
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-7681
Mailing Address - Country:US
Mailing Address - Phone:407-286-1829
Mailing Address - Fax:
Practice Address - Street 1:1650 SAND LAKE RD STE 112A
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-7671
Practice Address - Country:US
Practice Address - Phone:407-286-1829
Practice Address - Fax:407-286-3291
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JAI HO MALABAR MEDICAL WALK IN CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-22
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 207QA0401X, 207R00000X, 207V00000X
FLME39710207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016834700Medicaid
FL1609321454OtherNPI NUMBER