Provider Demographics
NPI:1477594067
Name:JAIN, SANJIV K (MD)
Entity Type:Individual
Prefix:
First Name:SANJIV
Middle Name:K
Last Name:JAIN
Suffix:
Gender:M
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:P.O. BOX 8000
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91327-8000
Mailing Address - Country:US
Mailing Address - Phone:818-366-0474
Mailing Address - Fax:818-474-7530
Practice Address - Street 1:16101 VENTURA BLVD
Practice Address - Street 2:STE 240
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2513
Practice Address - Country:US
Practice Address - Phone:818-366-0474
Practice Address - Fax:818-360-6319
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA47841207L00000X, 207R00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA47841Medicare ID - Type Unspecified
CAF05722Medicare UPIN