Provider Demographics
NPI:1437121233
Name:JAIN, MANJULA (MD)
Entity Type:Individual
Prefix:MRS
First Name:MANJULA
Middle Name:
Last Name:JAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E. OLIVE AVENUE, SUITE 740
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91501
Mailing Address - Country:US
Mailing Address - Phone:818-391-1038
Mailing Address - Fax:818-955-5136
Practice Address - Street 1:500 E. OLIVE AVENUE, SUITE 740
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91501
Practice Address - Country:US
Practice Address - Phone:818-391-1038
Practice Address - Fax:818-955-5136
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53512207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A535120Medicare UPIN
CAWA53512ZMedicare PIN