Provider Demographics
NPI:1801975925
Name:KINI, JAYANTHI (MD)
Entity type:Individual
Prefix:DR
First Name:JAYANTHI
Middle Name:
Last Name:KINI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 INTERNATIONAL WAY
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-1047
Mailing Address - Country:US
Mailing Address - Phone:541-341-8063
Mailing Address - Fax:541-341-8099
Practice Address - Street 1:123 INTERNATIONAL WAY
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-1047
Practice Address - Country:US
Practice Address - Phone:541-341-8063
Practice Address - Fax:541-341-8099
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00038975207ZP0102X
ORMD152979207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AB33794Medicare ID - Type Unspecified
E67103Medicare UPIN