Provider Demographics
NPI:1346447646
Name:JAHANDAR REZA SALEH MD INC
Entity Type:Organization
Organization Name:JAHANDAR REZA SALEH MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAHANDAR
Authorized Official - Middle Name:REZA
Authorized Official - Last Name:SALEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-917-3725
Mailing Address - Street 1:18350 ROSCOE BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-4109
Mailing Address - Country:US
Mailing Address - Phone:818-678-4900
Mailing Address - Fax:
Practice Address - Street 1:18350 ROSCOE BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4109
Practice Address - Country:US
Practice Address - Phone:818-678-4900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74385207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW21207Medicare PIN