MEDICARE: MANJULA JAIN MD, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	A53512	CA

General Provider Information

NPI Number	:	1841223880
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANJULA JAIN MD, INC.

Provider Business Mailing Address
First Line	:	500 E. OLIVE AVENUE, SUITE 740
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91501
Country	:	US
Telephone Number	:	818-391-1038
Fax Number	:	818-955-5136

Provider Business Practice Location Address
First Line	:	500 E. OLIVE AVENUE, SUITE 740
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91501
Country	:	US
Telephone Number	:	818-391-1038
Fax Number	:	818-955-5136

Authorized Official
Title or Position	:	CEO
Name	:	DR. MANJULA JAIN
Credential	:	M.D.
Telephone Number	:	818-391-1038

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	09/29/2020

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