Provider Demographics
NPI:1194469346
Name:NICKUL S. JAIN MD, A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:NICKUL S. JAIN MD, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICKUL
Authorized Official - Middle Name:S
Authorized Official - Last Name:JAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-689-0845
Mailing Address - Street 1:3501 JAMBOREE RD STE 1250
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2959
Mailing Address - Country:US
Mailing Address - Phone:949-988-7800
Mailing Address - Fax:
Practice Address - Street 1:3501 JAMBOREE RD STE 1250
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2959
Practice Address - Country:US
Practice Address - Phone:949-988-7800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-25
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty