Provider Demographics
NPI:1528011970
Name:JAIN, SAURABH (MD,MRCS)
Entity Type:Individual
Prefix:
First Name:SAURABH
Middle Name:
Last Name:JAIN
Suffix:
Gender:M
Credentials:MD,MRCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 S SAN FERNANDO BLVD APT 321
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-1371
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1200 N STATE STREET #1108
Practice Address - Street 2:LOS ANGELES COUNTY UNIVERSITY OF SOUTHERN CALIFORNIA
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033
Practice Address - Country:US
Practice Address - Phone:323-226-6225
Practice Address - Fax:818-351-8126
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA96287208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A962870Medicaid
CABG735WMedicare PIN