Provider Demographics
NPI:1023180650
Name:SERADJ, JOHN BAHRAM (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:BAHRAM
Last Name:SERADJ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BAHRAM
Other - Middle Name:
Other - Last Name:SERADJ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:477 N EL CAMINO REAL
Mailing Address - Street 2:SUITE A308
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-1328
Mailing Address - Country:US
Mailing Address - Phone:760-942-6120
Mailing Address - Fax:760-942-8187
Practice Address - Street 1:477 N EL CAMINO REAL
Practice Address - Street 2:SUITE A300
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024
Practice Address - Country:US
Practice Address - Phone:760-942-6120
Practice Address - Fax:760-942-8187
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32900207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A84405Medicare UPIN