Provider Demographics
NPI:1174704126
Name:JYOTIN K PATEL M,D. A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:JYOTIN K PATEL M,D. A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JYOTIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-363-5322
Mailing Address - Street 1:30110 CROWN VALLEY PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-2043
Mailing Address - Country:US
Mailing Address - Phone:949-363-5322
Mailing Address - Fax:
Practice Address - Street 1:30110 CROWN VALLEY PKWY
Practice Address - Street 2:STE 101
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-2043
Practice Address - Country:US
Practice Address - Phone:949-363-5322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19419Medicare PIN