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General NPI Number Information
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NPI Number | 1841223880
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Entity Type | Organization
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Legal Business Name | MANJULA JAIN MD, INC.
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 09/29/2020
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Provider Practice Location Address
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Address Line | 500 E. OLIVE AVENUE, SUITE 740
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City | BURBANK
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State | CA
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Zip | 91501
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Country | US
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Telephone | 818-391-1038
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Fax | 818-955-5136
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Provider Business Mailing Address
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Address Line | 500 E. OLIVE AVENUE, SUITE 740
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City | BURBANK
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State | CA
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Zip | 91501
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Country | US
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Telephone | 818-391-1038
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Fax | 818-955-5136
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Authorized Official
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Title or Position | CEO
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Name | DR. MANJULA JAIN
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Credential | M.D.
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Telephone | 818-391-1038
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A53512
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License Number State | CA
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