Provider Demographics
NPI:1609836972
Name:JAVAHERIAN, VAHID (DO)
Entity Type:Individual
Prefix:
First Name:VAHID
Middle Name:
Last Name:JAVAHERIAN
Suffix:
Gender:M
Credentials:DO
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 4039
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92863-4039
Mailing Address - Country:US
Mailing Address - Phone:714-571-5000
Mailing Address - Fax:
Practice Address - Street 1:315 N 3RD AVE STE 207
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-1917
Practice Address - Country:US
Practice Address - Phone:626-967-4469
Practice Address - Fax:626-967-4889
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6352207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF84290Medicare UPIN