Provider Demographics
NPI:1902290109
Name:MELEKH-SHALOM, JONATHAN (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:MELEKH-SHALOM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JONATHAN
Other - Middle Name:
Other - Last Name:SHALOM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:50 N LA CIENEGA BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2246
Mailing Address - Country:US
Mailing Address - Phone:818-570-0648
Mailing Address - Fax:231-447-3138
Practice Address - Street 1:50 N LA CIENEGA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2246
Practice Address - Country:US
Practice Address - Phone:657-514-0140
Practice Address - Fax:231-447-3138
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-25
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD3911005390200000X
CAA151749207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program