Provider Demographics
NPI:1992791180
Name:SAIN, ANIL K (MD)
Entity type:Individual
Prefix:DR
First Name:ANIL
Middle Name:K
Last Name:SAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 NORMAN DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-5900
Mailing Address - Country:US
Mailing Address - Phone:209-825-7748
Mailing Address - Fax:
Practice Address - Street 1:1140 NORMAN DR
Practice Address - Street 2:SUITE 1
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-5900
Practice Address - Country:US
Practice Address - Phone:209-825-7748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32483207R00000X, 207U00000X, 207UN0903X, 207UN0901X, 207UN0902X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
No207UN0903XAllopathic & Osteopathic PhysiciansNuclear MedicineIn Vivo & In Vitro Nuclear Medicine
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
No207UN0902XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Imaging & Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA324830Medicaid
CAA324834Medicare ID - Type Unspecified
CAA324830Medicaid