Provider Demographics
NPI:1720032808
Name:HAJISEYEDJAVADI, OMID (MD)
Entity type:Individual
Prefix:
First Name:OMID
Middle Name:
Last Name:HAJISEYEDJAVADI
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:OMID
Other - Middle Name:
Other - Last Name:JAVADI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:16696 CYPRESS WAY
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95030-7531
Mailing Address - Country:US
Mailing Address - Phone:408-896-9450
Mailing Address - Fax:408-213-7621
Practice Address - Street 1:105 N BASCOM AVE STE 202
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1811
Practice Address - Country:US
Practice Address - Phone:408-356-7205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-21
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY44129208G00000X
WI101490208G00000X
IL036.130433208G00000X
NV24220208G00000X
CAC55150208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZI52972Medicare UPIN