Healthcare Provider Details

I. General information

NPI: 1336376763
Provider Name (Legal Business Name): SHUBHA M JAIN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2009
Last Update Date: 10/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16101 VENTURA BLVD STE 240
ENCINO CA
91436-2513
US

IV. Provider business mailing address

PO BOX 8000
NORTHRIDGE CA
91327-8000
US

V. Phone/Fax

Practice location:
  • Phone: 818-366-0474
  • Fax: 818-360-6319
Mailing address:
  • Phone: 818-366-0474
  • Fax: 818-360-6319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SHUBHA M JAIN
Title or Position: CEO
Credential: MD
Phone: 818-366-0474