Provider Demographics
NPI:1720032808
Name:HAJISEYED JAVADI, OMID (MD)
Entity Type:Individual
Prefix:
First Name:OMID
Middle Name:
Last Name:HAJISEYED JAVADI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:OMID
Other - Middle Name:
Other - Last Name:JAVADI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6851 CANBY AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-4307
Mailing Address - Country:US
Mailing Address - Phone:818-668-8210
Mailing Address - Fax:818-668-8211
Practice Address - Street 1:2505 SAMARITAN DR
Practice Address - Street 2:STE. 503
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4006
Practice Address - Country:US
Practice Address - Phone:224-619-4937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-21
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY44129208G00000X
WI101490208G00000X
IL036.130433208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZI52972Medicare UPIN