Provider Demographics
NPI:1528009941
Name:JADVAR, HOSSEIN (MD)
Entity Type:Individual
Prefix:DR
First Name:HOSSEIN
Middle Name:
Last Name:JADVAR
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:PO BOX 31309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-0309
Mailing Address - Country:US
Mailing Address - Phone:323-442-8541
Mailing Address - Fax:323-442-8755
Practice Address - Street 1:1510 SAN PABLO ST FL 3
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5320
Practice Address - Country:US
Practice Address - Phone:323-442-8541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG79981207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G799810OtherBLUE SHIELD
CA00G799810G56OtherCAL-OPTIMA
CAP00347647OtherRAIL ROAD MEDICARE
CAP00347647OtherRAIL ROAD MEDICARE
CAH00048Medicare UPIN
CAWG79981FMedicare PIN
CAWG79981EMedicare PIN
CA00G799810G56OtherCAL-OPTIMA
CAWG79981CMedicare PIN
CA00G799810OtherBLUE SHIELD