Provider Demographics
NPI:1912248915
Name:SAURABH JAIN MD INC
Entity Type:Organization
Organization Name:SAURABH JAIN MD INC
Other - Org Name:WOUND CARE SURGEON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAURABH
Authorized Official - Middle Name:
Authorized Official - Last Name:JAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-726-2148
Mailing Address - Street 1:7301 TOPANGA CANYON BLVD
Mailing Address - Street 2:330
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-1357
Mailing Address - Country:US
Mailing Address - Phone:818-636-6749
Mailing Address - Fax:818-356-4380
Practice Address - Street 1:7301 TOPANGA CANYON BLVD
Practice Address - Street 2:330
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-1357
Practice Address - Country:US
Practice Address - Phone:818-220-3393
Practice Address - Fax:818-356-4380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-15
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA543454208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADU9640OtherMEDICARE RAILROAD PIN
CA1912248915Medicaid
CA1912248915Medicaid
TXZMHQ391696Medicare PIN
CAHD271AMedicare PIN
WAG8932416Medicare PIN