Provider Demographics
NPI:1104870138
Name:JAIN, SHALINI (MD)
Entity type:Individual
Prefix:MRS
First Name:SHALINI
Middle Name:
Last Name:JAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHALINI
Other - Middle Name:
Other - Last Name:JAIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:22601 PACIFIC COAST HWY
Mailing Address - Street 2:STE 240
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265
Mailing Address - Country:US
Mailing Address - Phone:310-456-6505
Mailing Address - Fax:310-456-8105
Practice Address - Street 1:22601 PACIFIC COAST HWY
Practice Address - Street 2:STE 240
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265
Practice Address - Country:US
Practice Address - Phone:310-456-6505
Practice Address - Fax:310-456-8105
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82789207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine