Provider Demographics
NPI:1861912289
Name:MEHTA, JITEN PRAKASH (D0)
Entity type:Individual
Prefix:DR
First Name:JITEN
Middle Name:PRAKASH
Last Name:MEHTA
Suffix:
Gender:M
Credentials:D0
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Mailing Address - Street 1:12665 GARDEN GROVE BLVD STE 211
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-1916
Mailing Address - Country:US
Mailing Address - Phone:714-636-2890
Mailing Address - Fax:
Practice Address - Street 1:1310 W STEWART DR STE 210
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3837
Practice Address - Country:US
Practice Address - Phone:714-836-4204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA17684207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology