NPIMap

Individual provider Active NPI

Daksha Ashok Jain, MD

  • Pediatrics Physician
  • Upland, CA
National Provider Identifier
1215019591
Registry record updated Jun 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
A43228 Issued in CA
Practice address
1175 E Arrow Hwy
Unit # M
Upland, CA 91786-5525
Phone
(909) 481-2494
Fax
(909) 481-2853
NPI assigned
Oct 19, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 10, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X A43228 CA Primary

Addresses

Primary practice location

1175 E Arrow Hwy
Unit # M
Upland, CA 91786-5525

Mailing address

1175 E Arrow Hwy
Unit # M
Upland, CA 91786-5525
Phone (909) 481-2494

Other identifiers 1

IdentifierTypeStateIssuer
00A432282MedicaidCA

Other names 1

  • Daksha Amritlal Shah Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A43228CAMDPediatrics Physician

Practice roles (5 of 6)

OrganizationSpecialtyStatusNew patients
San Antonio Regional Hospital Past Accepting new patients
Sushil Anand & Associates Medical Corp Pediatrics Past Accepting new patients
Sushil Anand M.D., Faap Past Accepting new patients
Pomona Valley Hospital Medical Center Past Accepting new patients
Prime Healthcare Services - Montclair, LLC Past Accepting new patients

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433894400000",
    "number": "1215019591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1175 E ARROW HWY",
            "address_2": "UNIT # M",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917865525",
            "telephone_number": "909-481-2494",
            "fax_number": "909-481-2853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1175 E ARROW HWY",
            "address_2": "UNIT # M",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917865525",
            "telephone_number": "909-481-2494",
            "fax_number": "909-481-2853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAIN",
        "first_name": "DAKSHA",
        "middle_name": "ASHOK",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-19",
        "last_updated": "2015-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A43228",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A432282",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DAKSHA",
            "last_name": "SHAH",
            "middle_name": "AMRITLAL",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Upland, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.