Provider Demographics
NPI:1548384746
Name:SAJADIAN, MORTEZA (MD)
Entity Type:Individual
Prefix:DR
First Name:MORTEZA
Middle Name:
Last Name:SAJADIAN
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 2016
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92885-1216
Mailing Address - Country:US
Mailing Address - Phone:714-218-1829
Mailing Address - Fax:714-777-8967
Practice Address - Street 1:1818 N ORANGE GROVE AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-3028
Practice Address - Country:US
Practice Address - Phone:909-865-3000
Practice Address - Fax:909-865-6223
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2008-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC42140208600000X
CAHC421402086S0129X, 208G00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
HC42140Medicare ID - Type Unspecified