Provider Demographics
NPI:1871769893
Name:PAM K. JANDA, M.D., INC.
Entity type:Organization
Organization Name:PAM K. JANDA, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAM
Authorized Official - Middle Name:K
Authorized Official - Last Name:JANDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-449-8200
Mailing Address - Street 1:6045 N 1ST ST STE 103
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5444
Mailing Address - Country:US
Mailing Address - Phone:559-449-8200
Mailing Address - Fax:559-449-8217
Practice Address - Street 1:6045 N 1ST ST STE 103
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5444
Practice Address - Country:US
Practice Address - Phone:559-449-8200
Practice Address - Fax:559-449-8217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37511174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A375110Medicaid
CA00A375110Medicare PIN
CAA28396Medicare UPIN