Provider Demographics
NPI:1891852109
Name:SADJADI, JAVID (MD)
Entity type:Individual
Prefix:
First Name:JAVID
Middle Name:
Last Name:SADJADI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11175 CAMPUS ST STE 21111
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92350-1700
Mailing Address - Country:US
Mailing Address - Phone:909-651-5948
Mailing Address - Fax:909-558-0236
Practice Address - Street 1:11175 CAMPUS ST STE 21111
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92350-1700
Practice Address - Country:US
Practice Address - Phone:909-651-5948
Practice Address - Fax:909-558-0236
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91633208600000X
NM390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery