1538514252 NPI number — SANJIV JAIN & SHUBHA JAIN MD INC

Table of content: (NPI 1538514252)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538514252 NPI number — SANJIV JAIN & SHUBHA JAIN MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANJIV JAIN & SHUBHA JAIN MD INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CENTER FOR PAIN CONTROL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538514252
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11177 TAMPA AVE
Provider Second Line Business Mailing Address:
SUITE # B
Provider Business Mailing Address City Name:
NORTHRIDGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91326-2254
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-366-0474
Provider Business Mailing Address Fax Number:
818-474-7530

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11177 TAMPA AVE
Provider Second Line Business Practice Location Address:
SUITE # B
Provider Business Practice Location Address City Name:
NORTHRIDGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91326-2254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-366-0474
Provider Business Practice Location Address Fax Number:
818-474-7530
Provider Enumeration Date:
05/02/2016

Additional Information

Authorized Official

Authorized Official Last Name:
JAIN
Authorized Official First Name:
SHUBHA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
818-366-0474

Provider Taxonomy Codes

  • Taxonomy code: 261QP3300X , with the licence number:  A47841 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QP3300X , with the licence number: A54399 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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