Healthcare Provider Details

I. General information

NPI: 1215019591
Provider Name (Legal Business Name): DAKSHA ASHOK JAIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DAKSHA AMRITLAL SHAH MD

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 06/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 E ARROW HWY UNIT # M
UPLAND CA
91786-5525
US

IV. Provider business mailing address

1175 E ARROW HWY UNIT # M
UPLAND CA
91786-5525
US

V. Phone/Fax

Practice location:
  • Phone: 909-481-2494
  • Fax: 909-481-2853
Mailing address:
  • Phone: 909-481-2494
  • Fax: 909-481-2853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA43228
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: