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General NPI Number Information
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NPI Number | 1700811312
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Entity Type | Individual
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Provider Name | EDWARD J JAHNKE III M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 04/01/2015
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Provider Practice Location Address
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Address Line | 501 S BUENA VISTA ST
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City | BURBANK
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State | CA
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Zip | 91505-4809
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Country | US
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Telephone | 818-847-6983
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Fax |
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Provider Business Mailing Address
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Address Line | 4100 GUARDIAN ST STE 205
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City | SIMI VALLEY
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State | CA
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Zip | 93063-6717
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Country | US
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Telephone | 805-522-5940
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Fax | 805-577-2018
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | G46668
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License Number State | CA
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