Provider Demographics
NPI:1053624189
Name:JAIN, PRAGYA (MD)
Entity type:Individual
Prefix:
First Name:PRAGYA
Middle Name:
Last Name:JAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PRAGYA
Other - Middle Name:
Other - Last Name:KUMBHAT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1301 SHOREWAY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002-4110
Mailing Address - Country:US
Mailing Address - Phone:650-596-7000
Mailing Address - Fax:650-596-7096
Practice Address - Street 1:1301 SHOREWAY RD STE 100
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:CA
Practice Address - Zip Code:94002-4110
Practice Address - Country:US
Practice Address - Phone:650-596-7000
Practice Address - Fax:650-596-7096
Is Sole Proprietor?:No
Enumeration Date:2010-07-18
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA120149207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine