Provider Demographics
NPI:1972558807
Name:JAIN, ARTI (MD)
Entity type:Individual
Prefix:DR
First Name:ARTI
Middle Name:
Last Name:JAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:555 KNOWLES DRIVE
Mailing Address - Street 2:SUITE 219
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-1551
Mailing Address - Country:US
Mailing Address - Phone:408-378-6171
Mailing Address - Fax:408-378-0721
Practice Address - Street 1:555 KNOWLES DRIVE
Practice Address - Street 2:SUITE 219
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1551
Practice Address - Country:US
Practice Address - Phone:408-378-6171
Practice Address - Fax:408-378-0721
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO43302208000000X
CAA77790208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO91273544Medicaid
CO805121Medicare ID - Type Unspecified
COH81029Medicare UPIN