Provider Demographics
NPI:1891852109
Name:SADJADI, JAVID (MD)
Entity Type:Individual
Prefix:
First Name:JAVID
Middle Name:
Last Name:SADJADI
Suffix:
Gender:M
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:MSC10 5610
Mailing Address - Street 2:1 UNIVERSITY OF NEW MEXICO
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:81731
Mailing Address - Country:US
Mailing Address - Phone:505-272-4161
Mailing Address - Fax:505-272-2776
Practice Address - Street 1:MSC10 5610 1 UNIVERSITY OF NEW MEXICO
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-1018
Practice Address - Country:US
Practice Address - Phone:505-272-4161
Practice Address - Fax:510-272-2776
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91633208600000X
NM390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No208600000XAllopathic & Osteopathic PhysiciansSurgery