Healthcare Provider Details

I. General information

NPI: 1720299928
Provider Name (Legal Business Name): JOHN JAIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2007
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 BROADWAY
SANTA MONICA CA
90404-2711
US

IV. Provider business mailing address

1441 BROADWAY
SANTA MONICA CA
90404-2711
US

V. Phone/Fax

Practice location:
  • Phone: 310-905-8001
  • Fax:
Mailing address:
  • Phone: 310-905-8001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberG77315
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: