Provider Demographics
NPI:1457702524
Name:JAVAN, NAVID
Entity type:Individual
Prefix:
First Name:NAVID
Middle Name:
Last Name:JAVAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 UNIVERSITY CIR
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-3200
Mailing Address - Country:US
Mailing Address - Phone:209-667-3396
Mailing Address - Fax:
Practice Address - Street 1:1 UNIVERSITY CIR
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-3200
Practice Address - Country:US
Practice Address - Phone:209-667-3396
Practice Address - Fax:209-667-3195
Is Sole Proprietor?:No
Enumeration Date:2016-06-29
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFJ8171073207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine