Provider Demographics
NPI:1083450969
Name:JAIN, DIMPLE K
Entity type:Individual
Prefix:
First Name:DIMPLE
Middle Name:K
Last Name:JAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1857 CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-2129
Mailing Address - Country:US
Mailing Address - Phone:805-300-6452
Mailing Address - Fax:
Practice Address - Street 1:1911 WILLIAMS DR STE 200
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-0673
Practice Address - Country:US
Practice Address - Phone:866-998-2243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program