Provider Demographics
NPI:1639156979
Name:JAIN, INDU (MD)
Entity Type:Individual
Prefix:
First Name:INDU
Middle Name:
Last Name:JAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2858
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93539-2858
Mailing Address - Country:US
Mailing Address - Phone:661-729-6854
Mailing Address - Fax:661-729-6864
Practice Address - Street 1:1672 W AVENUE J
Practice Address - Street 2:SUITE 209
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2827
Practice Address - Country:US
Practice Address - Phone:661-729-6854
Practice Address - Fax:661-729-6864
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA48352207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A483520Medicaid
CA00A483520Medicaid