Provider Demographics
NPI:1194905711
Name:JAIN, ATUL KUMAR (MD)
Entity type:Individual
Prefix:
First Name:ATUL
Middle Name:KUMAR
Last Name:JAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7695 CARDINAL COURT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-3357
Mailing Address - Country:US
Mailing Address - Phone:858-609-7100
Mailing Address - Fax:858-609-7100
Practice Address - Street 1:7695 CARDINAL COURT
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-3357
Practice Address - Country:US
Practice Address - Phone:858-609-7100
Practice Address - Fax:858-609-7100
Is Sole Proprietor?:No
Enumeration Date:2007-11-12
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA92495207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A924950Medicaid
WA92495AMedicare PIN
CA00A924950Medicaid
13678Medicare UPIN
CA13678Medicare UPIN