Provider Demographics
NPI:1831200633
Name:EVELYN JANKOWSKI MD INC
Entity type:Organization
Organization Name:EVELYN JANKOWSKI MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NPC
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:NPC
Authorized Official - Phone:818-368-5651
Mailing Address - Street 1:10316 WOODLEY AVE
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344
Mailing Address - Country:US
Mailing Address - Phone:813-368-5651
Mailing Address - Fax:818-363-4770
Practice Address - Street 1:10316 WOODLEY AVE
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344
Practice Address - Country:US
Practice Address - Phone:813-368-5651
Practice Address - Fax:818-363-4770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG032630207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W14505Medicare ID - Type Unspecified
A45222Medicare UPIN