Provider Demographics
NPI:1548288491
Name:AUTAR, JAI CHAND (MD)
Entity type:Individual
Prefix:MR
First Name:JAI
Middle Name:CHAND
Last Name:AUTAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 E WASHINGTON BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CRESCENT CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95531-8397
Mailing Address - Country:US
Mailing Address - Phone:707-464-6715
Mailing Address - Fax:
Practice Address - Street 1:780 E WASHINGTON BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531-8397
Practice Address - Country:US
Practice Address - Phone:707-464-6715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP642174400000X
CAA99944208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No174400000XOther Service ProvidersSpecialist