=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487923207
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MADHUKAR B. JIGJINNI, M.D., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/22/2011
-----------------------------------------------------
Last Update Date | 12/22/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 999 N TUSTIN AVE STE 115
-----------------------------------------------------
City | SANTA ANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92705-6505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-973-2188
-----------------------------------------------------
Fax | 714-973-2187
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 999 N TUSTIN AVE STE 115
-----------------------------------------------------
City | SANTA ANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92705-6505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-973-2188
-----------------------------------------------------
Fax | 714-973-2187
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICER
-----------------------------------------------------
Name | DR. MADHUKAR B. JIGJINNI
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 714-973-2188
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | A35320
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------