Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 100274 | CA |
NPI | 1104276765 |
---|---|
Provider Name | Behdad Javdan |
First Address | Sacramento, CA 95841-4622 |
Second Address | Sacramento, CA 95841-4622 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2016 |
Last Update Date | 15/06/2016 |