Provider Demographics
NPI:1750403382
Name:JASBIR S MANN M D INC A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:JASBIR S MANN M D INC A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASBIR
Authorized Official - Middle Name:S
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-895-1774
Mailing Address - Street 1:PO BOX 2007
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92837-0007
Mailing Address - Country:US
Mailing Address - Phone:714-895-1774
Mailing Address - Fax:714-758-1485
Practice Address - Street 1:1771 W ROMNEYA DR
Practice Address - Street 2:SUITE E
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-1817
Practice Address - Country:US
Practice Address - Phone:714-895-1774
Practice Address - Fax:714-758-1485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35052261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A350520Medicaid
CA00A350520Medicaid
CAE01620Medicare UPIN