Provider Demographics
NPI:1649386558
Name:JAIN, RAVIN (MD)
Entity Type:Individual
Prefix:
First Name:RAVIN
Middle Name:
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 1:2625 W ALAMEDA AVE STE 322
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4822
Mailing Address - Country:US
Mailing Address - Phone:818-845-2255
Mailing Address - Fax:
Practice Address - Street 1:2625 W ALAMEDA AVE STE 322
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4822
Practice Address - Country:US
Practice Address - Phone:818-845-2255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA525282084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A525280Medicaid
CAWA52528BMedicare PIN
CABZ020RMedicare PIN