Provider Demographics
NPI:1437420072
Name:HAGGIAGI, JEHAD (MD)
Entity Type:Individual
Prefix:
First Name:JEHAD
Middle Name:
Last Name:HAGGIAGI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11550 INDIAN HILLS RD
Mailing Address - Street 2:STE 371
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-1252
Mailing Address - Country:US
Mailing Address - Phone:818-365-1194
Mailing Address - Fax:818-898-3835
Practice Address - Street 1:11550 INDIAN HILLS RD
Practice Address - Street 2:SUITE 371
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1252
Practice Address - Country:US
Practice Address - Phone:818-365-1194
Practice Address - Fax:818-898-3835
Is Sole Proprietor?:No
Enumeration Date:2012-01-12
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014010412207R00000X
CAA140556207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1437420072Medicaid
CA1437420072Medicaid