Provider Demographics
NPI:1720021397
Name:AMIN, JATIN N (MD)
Entity Type:Individual
Prefix:
First Name:JATIN
Middle Name:N
Last Name:AMIN
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 1:3770 ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2527
Mailing Address - Country:US
Mailing Address - Phone:951-352-3937
Mailing Address - Fax:951-352-2839
Practice Address - Street 1:3770 ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2527
Practice Address - Country:US
Practice Address - Phone:951-352-3937
Practice Address - Fax:951-352-2839
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG82118207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G821180Medicaid
CAG39643Medicare UPIN
WG82118Medicare PIN
00G821180Medicare PIN
00G821181Medicare PIN
CA00G821180Medicaid