Healthcare Provider Details

I. General information

NPI: 1902290109
Provider Name (Legal Business Name): JONATHAN MELEKH-SHALOM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JONATHAN SHALOM M.D.

II. Dates (important events)

Enumeration Date: 03/25/2015
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9454 WILSHIRE BLVD STE 205
BEVERLY HILLS CA
90212-2903
US

IV. Provider business mailing address

9454 WILSHIRE BLVD STE 205
BEVERLY HILLS CA
90212-2903
US

V. Phone/Fax

Practice location:
  • Phone: 310-370-7080
  • Fax: 310-684-2089
Mailing address:
  • Phone: 310-370-7080
  • Fax: 310-684-2089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA151749
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: