Provider Demographics
NPI:1750602900
Name:KOTHARI, JAY S (MD)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:S
Last Name:KOTHARI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3181 SW SAM JACKSON PARK RD
Mailing Address - Street 2:DEPT OF PSYCHIATRY, C/O ROCIO POZO
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3011
Mailing Address - Country:US
Mailing Address - Phone:503-494-8250
Mailing Address - Fax:503-494-6170
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:DEPT OF PSYCHIATRY, C/O ROCIO POZO
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3011
Practice Address - Country:US
Practice Address - Phone:503-494-8250
Practice Address - Fax:503-494-6170
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2016-06-16
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Provider Licenses
StateLicense IDTaxonomies
ORMD1766512084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry