Provider Demographics
NPI:1629239892
Name:POLADIAN, JACKLIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JACKLIN
Middle Name:
Last Name:POLADIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 SOUTH FAIRMOUNT AVE.
Mailing Address - Street 2:SUITE 420
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3154
Mailing Address - Country:US
Mailing Address - Phone:626-200-4500
Mailing Address - Fax:626-795-0704
Practice Address - Street 1:800 SOUTH FAIRMOUNT AVE.
Practice Address - Street 2:SUITE 420
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
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-20
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA110327207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine