Provider Demographics
NPI:1952370066
Name:JAIN, KIRTI K (MD)
Entity Type:Individual
Prefix:
First Name:KIRTI
Middle Name:K
Last Name:JAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 SAINT CHRISTOPHER DR
Mailing Address - Street 2:122 SAINT CHRISTOPHER DR
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7016
Mailing Address - Country:US
Mailing Address - Phone:606-836-0202
Mailing Address - Fax:606-836-2189
Practice Address - Street 1:122 SAINT CHRISTOPHER DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101
Practice Address - Country:US
Practice Address - Phone:606-836-0202
Practice Address - Fax:606-836-2189
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY23276207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64232762Medicaid
KY64232762Medicaid
0215005Medicare PIN