Provider Demographics
NPI:1356592802
Name:SUNIL K JAIN MD PLLC
Entity type:Organization
Organization Name:SUNIL K JAIN MD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNIL
Authorized Official - Middle Name:K
Authorized Official - Last Name:JAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-327-5093
Mailing Address - Street 1:9878 E ACACIA DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2376
Mailing Address - Country:US
Mailing Address - Phone:602-327-5093
Mailing Address - Fax:602-251-8895
Practice Address - Street 1:525 N 18TH ST
Practice Address - Street 2:SUITE 403
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-4102
Practice Address - Country:US
Practice Address - Phone:602-327-5093
Practice Address - Fax:602-251-8895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-02
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ341162081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ10809160OtherCAQH
AZ947864Medicaid
G28907Medicare UPIN