Provider Demographics
NPI:1790050052
Name:JAIN, SANJAY
Entity Type:Individual
Prefix:
First Name:SANJAY
Middle Name:
Last Name:JAIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6431 FANNIN
Mailing Address - Street 2:SUITE MSB 2.116
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-5389
Mailing Address - Country:US
Mailing Address - Phone:713-500-7640
Mailing Address - Fax:713-500-7647
Practice Address - Street 1:6431 FANNIN
Practice Address - Street 2:SUITE MSB 2.116
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-5389
Practice Address - Country:US
Practice Address - Phone:713-500-7640
Practice Address - Fax:713-500-7647
Is Sole Proprietor?:No
Enumeration Date:2012-03-19
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ80802085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology