Provider Demographics
NPI:1669575106
Name:JAVDAN, FRED (MD)
Entity type:Individual
Prefix:
First Name:FRED
Middle Name:
Last Name:JAVDAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:FARID
Other - Middle Name:
Other - Last Name:JAVEDANFAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:700 N BRAND BLVD STE 1400
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-4263
Mailing Address - Country:US
Mailing Address - Phone:818-839-5200
Mailing Address - Fax:818-844-3887
Practice Address - Street 1:700 N BRAND BLVD STE 1400
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-4263
Practice Address - Country:US
Practice Address - Phone:818-839-5200
Practice Address - Fax:818-844-3887
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76858207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA76858OtherMEDICARE PTAN