Basic Information
| Provider Information | |||||||||
| NPI: | 1275598765 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | JYOTINKUMAR | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30281 GOLDEN LANTERN | ||||||||
| Address2: | |||||||||
| City: | LAGUNA NIGUEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926775979 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4994957144 | ||||||||
| FaxNumber: | 9494950270 | ||||||||
| Practice Location | |||||||||
| Address1: | 30281 GOLDEN LANTERN | ||||||||
| Address2: | |||||||||
| City: | LAGUNA NIGUEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926775979 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9494957144 | ||||||||
| FaxNumber: | 9494950270 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2006 | ||||||||
| LastUpdateDate: | 06/23/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 06/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | A43752 | CA | Y | Allopathic & Osteopathic Physicians | General Practice | 207Q00000X | A43752 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine | 208000000X | A43752 | CA | N | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | W19419 | 01 | CA | GROUP ID | OTHER |