Provider Demographics
NPI:1720314107
Name:JABBARI, SIAVASH (MD)
Entity Type:Individual
Prefix:DR
First Name:SIAVASH
Middle Name:
Last Name:JABBARI
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 1:5725 KEARNY VILLA ROAD
Mailing Address - Street 2:SUITE I
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123
Mailing Address - Country:US
Mailing Address - Phone:858-256-0351
Mailing Address - Fax:858-256-0355
Practice Address - Street 1:3075 HEALTH CENTER DRIVE
Practice Address - Street 2:LEVEL 0
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123
Practice Address - Country:US
Practice Address - Phone:858-939-5010
Practice Address - Fax:858-939-5015
Is Sole Proprietor?:No
Enumeration Date:2009-10-20
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA992692085R0001X
IL036-1254632085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA99269OtherBLUE CROSS
CAA99269OtherSRS