Provider Demographics
NPI:1841228384
Name:JAIN, SUPRABHA N (MD)
Entity type:Individual
Prefix:DR
First Name:SUPRABHA
Middle Name:N
Last Name:JAIN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3496 BUSKIRK AVE
Mailing Address - Street 2:STE 103
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-4368
Mailing Address - Country:US
Mailing Address - Phone:925-935-5425
Mailing Address - Fax:925-947-2671
Practice Address - Street 1:3496 BUSKIRK AVE
Practice Address - Street 2:STE 103
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-4368
Practice Address - Country:US
Practice Address - Phone:925-935-5425
Practice Address - Fax:925-947-2671
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2021-12-20
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Provider Licenses
StateLicense IDTaxonomies
CAA67699207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA173631Medicare PIN
CAH04887Medicare UPIN