Provider Demographics
NPI:1215019591
Name:JAIN, DAKSHA ASHOK (MD)
Entity Type:Individual
Prefix:
First Name:DAKSHA
Middle Name:ASHOK
Last Name:JAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DAKSHA
Other - Middle Name:AMRITLAL
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1175 E ARROW HWY
Mailing Address - Street 2:UNIT # M
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-5525
Mailing Address - Country:US
Mailing Address - Phone:909-481-2494
Mailing Address - Fax:909-481-2853
Practice Address - Street 1:1175 E ARROW HWY
Practice Address - Street 2:UNIT # M
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-5525
Practice Address - Country:US
Practice Address - Phone:909-481-2494
Practice Address - Fax:909-481-2853
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43228208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A432282Medicaid