MEDICARE: SHUBHA MEHTA JAIN A MEDICAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	A54399	CA

General Provider Information

NPI Number	:	1083842595
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHUBHA MEHTA JAIN A MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	1377 WEST SUNSET BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-4449
Country	:	US
Telephone Number	:	213-426-8333
Fax Number	:

Provider Business Practice Location Address
First Line	:	1377 WEST SUNSET BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-4449
Country	:	US
Telephone Number	:	213-426-8333
Fax Number	:

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	DR. SHUBHA MEHTA JAIN
Credential	:	MD
Telephone Number	:	213-426-8333

Provider Enumeration Date	:	06/24/2009
Last Update Date	:	06/24/2009

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