Provider Demographics
NPI:1437555836
Name:OMID H. JAVADI PC
Entity Type:Organization
Organization Name:OMID H. JAVADI PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OMID
Authorized Official - Middle Name:H
Authorized Official - Last Name:JAVADI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:224-619-4937
Mailing Address - Street 1:6851 CANBY AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-4307
Mailing Address - Country:US
Mailing Address - Phone:818-668-8210
Mailing Address - Fax:818-668-8211
Practice Address - Street 1:2505 SAMARITAN DR
Practice Address - Street 2:STE 503
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4006
Practice Address - Country:US
Practice Address - Phone:224-619-4937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-12
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC55150208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty