Provider Demographics
NPI:1952939902
Name:JAIN, RENUKA SACHDEVA (MD)
Entity Type:Individual
Prefix:
First Name:RENUKA
Middle Name:SACHDEVA
Last Name:JAIN
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 1:4250 SAINT ANDREWS PL
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45236-1056
Mailing Address - Country:US
Mailing Address - Phone:303-345-3633
Mailing Address - Fax:
Practice Address - Street 1:571 S FLOYD ST STE 412
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3877
Practice Address - Country:US
Practice Address - Phone:502-629-8828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-27
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.147353208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No208000000XAllopathic & Osteopathic PhysiciansPediatrics