Provider Demographics
NPI:1740212703
Name:UTTAM, JAI (MD)
Entity Type:Individual
Prefix:MR
First Name:JAI
Middle Name:
Last Name:UTTAM
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 1:2210 HASTINGS DR
Mailing Address - Street 2:APT 209
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002-3373
Mailing Address - Country:US
Mailing Address - Phone:559-375-3340
Mailing Address - Fax:650-367-5230
Practice Address - Street 1:170 ALAMEDA DE LAS PULGAS
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-2751
Practice Address - Country:US
Practice Address - Phone:559-459-6000
Practice Address - Fax:650-367-5230
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA84812207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A848120OtherBLUE SHIELD OF CALIFORNIA
CA00A848120Medicaid
CA00A848120OtherBLUE SHIELD OF CALIFORNIA
GADL106ZMedicare PIN
CA00A848120Medicaid
CA00A848121Medicare PIN
CAP00427646Medicare PIN
CAP01510065Medicare PIN
I60295Medicare UPIN