Basic Information
| Provider Information | |||||||||
| NPI: | 1639156979 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JAIN | ||||||||
| FirstName: | INDU | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2858 | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935392858 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6617296854 | ||||||||
| FaxNumber: | 6617296864 | ||||||||
| Practice Location | |||||||||
| Address1: | 1672 W AVENUE J | ||||||||
| Address2: | SUITE 209 | ||||||||
| City: | LANCASTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935342827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6617296854 | ||||||||
| FaxNumber: | 6617296864 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2005 | ||||||||
| LastUpdateDate: | 11/01/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | A48352 | CA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 00A483520 | 05 | CA | MEDICAID |