Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | A124009 | CA |
N | 204E00000X | Oral & Maxillofacial Surgeon | DDS59583 | CA |
NPI | 1386847648 |
---|---|
Provider Name | Dr. Jayini S Thakker |
First Address | Loma Linda, CA 92350-1706 |
Second Address | Loma Linda, CA 92350-1801 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2007 |
Last Update Date | 12/10/2021 |