# RAJENDRA K JAIN UROLOGY INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1558496489
- **Authorized official:** DR. RAJENDRA KUMAR JAIN MD (MD)
- **Authorized official phone:** (304) 525-7716

## Contact information

- **Practice address:** 2828 FIRST AVE SUITE 204, HUNTINGTON, WV 25702
- **Practice address phone:** (304) 525-7716
- **Practice address fax:** (304) 525-7717
- **Mailing address:** 2828 FIRST AVE SUITE 204, HUNTINGTON, WV 25702
- **Mailing address phone:** (304) 525-7716
- **Mailing address fax:** (304) 525-7717

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208800000X | Urology Physician | WV11477 | WV | Yes |

## Other

- **Enumeration date:** 02/22/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0130577000 | — | WV |
| 01 | — | 0380387 | OH MEDICAID | OH |