Provider Demographics
NPI:1093258139
Name:JAIN, SALONEE
Entity Type:Individual
Prefix:
First Name:SALONEE
Middle Name:
Last Name:JAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 OLD SAN FRANCISCO RD APT 379
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94086-8027
Mailing Address - Country:US
Mailing Address - Phone:716-489-0088
Mailing Address - Fax:877-828-2060
Practice Address - Street 1:620 SAND HILL RD
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-2002
Practice Address - Country:US
Practice Address - Phone:888-926-1850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-21
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26001225100000X
CAPT2958842251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4374045-00Medicaid
MD1447657507OtherNPI TYPE 2/ ORGANIZATION
MD1447657507OtherNPI TYPE 2/ ORGANIZATION