Provider Demographics
NPI:1700851771
Name:JAIN, KIRN (MD)
Entity Type:Individual
Prefix:DR
First Name:KIRN
Middle Name:
Last Name:JAIN
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 1:301 RIVERVIEW AVE
Mailing Address - Street 2:SUITE 810
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1065
Mailing Address - Country:US
Mailing Address - Phone:757-252-9150
Mailing Address - Fax:757-510-9274
Practice Address - Street 1:301 RIVERVIEW AVE
Practice Address - Street 2:SUITE 810
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1065
Practice Address - Country:US
Practice Address - Phone:757-252-9150
Practice Address - Fax:757-510-9274
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101238673207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010195519Medicaid
VA010195519Medicaid
008384S33Medicare ID - Type Unspecified