Provider Demographics
NPI:1790951416
Name:JOHN P S JANDA MD, INC.
Entity Type:Organization
Organization Name:JOHN P S JANDA MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P S
Authorized Official - Last Name:JANDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-673-5921
Mailing Address - Street 1:720 E ALMOND AVE
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93637-5691
Mailing Address - Country:US
Mailing Address - Phone:559-673-5921
Mailing Address - Fax:559-674-3732
Practice Address - Street 1:720 E ALMOND AVE
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-5691
Practice Address - Country:US
Practice Address - Phone:559-673-5921
Practice Address - Fax:559-674-3732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-02
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37510174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A375101Medicaid
CA00A375101Medicaid
CAA28395Medicare UPIN