Provider Demographics
NPI:1821018045
Name:JAVAN, LEILIE JUNE (MD)
Entity Type:Individual
Prefix:DR
First Name:LEILIE
Middle Name:JUNE
Last Name:JAVAN
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 1:425 HAALAND DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91361-5229
Mailing Address - Country:US
Mailing Address - Phone:805-381-9800
Mailing Address - Fax:805-496-8480
Practice Address - Street 1:425 HAALAND DR
Practice Address - Street 2:SUITE 203
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-5229
Practice Address - Country:US
Practice Address - Phone:805-381-9800
Practice Address - Fax:805-496-8480
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG861012086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH64791Medicare UPIN
CAW19546Medicare ID - Type Unspecified
CAWG86101AMedicare ID - Type UnspecifiedMEDICARE PPIN