Provider Demographics
NPI:1689701450
Name:JAIN, SHONUL AGARWAL (MD)
Entity Type:Individual
Prefix:DR
First Name:SHONUL
Middle Name:AGARWAL
Last Name:JAIN
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:1001 POTRERO AVE
Mailing Address - Street 2:MAILSTOP 6E
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-3518
Mailing Address - Country:US
Mailing Address - Phone:415-206-8361
Mailing Address - Fax:415-206-3686
Practice Address - Street 1:1001 POTRERO AVE
Practice Address - Street 2:MAILSTOP 6E
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3518
Practice Address - Country:US
Practice Address - Phone:415-206-8361
Practice Address - Fax:415-206-3686
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA94229208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARES000Medicare UPIN