Provider Demographics
NPI:1952822959
Name:SANJIV KUMAR JAIN, MD., A CALIFORNIA MEDICAL CORPORATION
Entity Type:Organization
Organization Name:SANJIV KUMAR JAIN, MD., A CALIFORNIA MEDICAL CORPORATION
Other - Org Name:LA AMBULATORY SURGERY CENTER, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJIV
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:JAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-366-0474
Mailing Address - Street 1:PO 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:818-360-6319
Practice Address - Street 1:11177 TAMPA AVE STE B
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91326-2254
Practice Address - Country:US
Practice Address - Phone:818-366-0474
Practice Address - Fax:818-360-6319
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SANJIV KUMAR JAIN, MD., A CALIFORNIA MEDICAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-06-29
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA47841207L00000X, 261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty