Provider Demographics
NPI:1902878978
Name:RANGI, JAIWANT K (MD, FACE)
Entity Type:Individual
Prefix:
First Name:JAIWANT
Middle Name:K
Last Name:RANGI
Suffix:
Gender:F
Credentials:MD, FACE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2890
Mailing Address - Street 2:
Mailing Address - City:GRANITE BAY
Mailing Address - State:CA
Mailing Address - Zip Code:95746-2890
Mailing Address - Country:US
Mailing Address - Phone:530-677-0700
Mailing Address - Fax:530-676-3666
Practice Address - Street 1:1600 CREEKSIDE DR STE 2700
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3485
Practice Address - Country:US
Practice Address - Phone:530-677-0700
Practice Address - Fax:530-676-7850
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA92729207RE0101X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI47213Medicare UPIN