Provider Demographics
NPI:1750398020
Name:JAIN, VIVEK
Entity type:Individual
Prefix:
First Name:VIVEK
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 1:15000 LOS GATOS BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2017
Mailing Address - Country:US
Mailing Address - Phone:408-256-3144
Mailing Address - Fax:
Practice Address - Street 1:15000 LOS GATOS BLVD STE 1
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2017
Practice Address - Country:US
Practice Address - Phone:408-256-3144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69306207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH29720Medicare UPIN