Provider Demographics
NPI:1710973839
Name:JAIN, SANJEEV (MD; PHD)
Entity type:Individual
Prefix:DR
First Name:SANJEEV
Middle Name:
Last Name:JAIN
Suffix:
Gender:M
Credentials:MD; PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43575 MISSION BLVD
Mailing Address - Street 2:#716
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-5831
Mailing Address - Country:US
Mailing Address - Phone:360-609-7077
Mailing Address - Fax:510-744-9959
Practice Address - Street 1:1152 DOUGLAS ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2452
Practice Address - Country:US
Practice Address - Phone:360-940-0880
Practice Address - Fax:844-697-8702
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00040042207K00000X
CAG88329207K00000X
ORMD162938207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology