Provider Demographics
NPI:1679558605
Name:JAVIDAN-NEJAD, JAVID J (MD)
Entity type:Individual
Prefix:
First Name:JAVID
Middle Name:J
Last Name:JAVIDAN-NEJAD
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:3400 DATA DRIVE
Mailing Address - Street 2:CREDENTIALING DEPARTMENT
Mailing Address - City:RANCHO GORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:916-734-5154
Mailing Address - Fax:916-734-8094
Practice Address - Street 1:6620 COYLE AVENUE
Practice Address - Street 2:SUITE 301
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-6337
Practice Address - Country:US
Practice Address - Phone:916-961-2514
Practice Address - Fax:916-961-1182
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2013-12-20
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Provider Licenses
StateLicense IDTaxonomies
CAA83658208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A836580Medicaid
CA00A836580Medicare ID - Type Unspecified
CAH19771Medicare UPIN