Basic Information
| Provider Information | |||||||||
| NPI: | 1497989008 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BHAWNA JAIN M.D.INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30166 INDUSTRIAL PKWY SW # 272 | ||||||||
| Address2: | |||||||||
| City: | HAYWARD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945446906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5105797027 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1125 SIR FRANCIS DRAKE BLVD | ||||||||
| Address2: | |||||||||
| City: | KENTFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949041418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154569680 | ||||||||
| FaxNumber: | 4154853622 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2009 | ||||||||
| LastUpdateDate: | 05/11/2009 | ||||||||
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| AuthorizedOfficialLastName: | JAIN | ||||||||
| AuthorizedOfficialFirstName: | BHAWNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5105797027 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A68306 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.