Provider Demographics
NPI:1629837455
Name:JAIN, AVNI (MD, FRCPC)
Entity Type:Individual
Prefix:
First Name:AVNI
Middle Name:
Last Name:JAIN
Suffix:
Gender:F
Credentials:MD, FRCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 ANTON BLVD UNIT 1306
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-1968
Mailing Address - Country:US
Mailing Address - Phone:613-884-7863
Mailing Address - Fax:
Practice Address - Street 1:101 THE CITY DR S BLDG 22C
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3201
Practice Address - Country:US
Practice Address - Phone:714-456-2249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA193776207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology