Provider Demographics
NPI:1598033920
Name:JACKLIN POLADIAN, M.D., INC.
Entity Type:Organization
Organization Name:JACKLIN POLADIAN, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACKLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:POLADIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-200-4500
Mailing Address - Street 1:301 S FAIR OAKS AVE
Mailing Address - Street 2:SUITE 403
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2561
Mailing Address - Country:US
Mailing Address - Phone:626-200-4500
Mailing Address - Fax:626-795-0704
Practice Address - Street 1:800 FAIRMOUNT AVE STE 420
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3154
Practice Address - Country:US
Practice Address - Phone:626-200-4500
Practice Address - Fax:626-795-0704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-13
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA110327261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care