Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | G79981 | CA |
NPI | 1528009941 |
---|---|
Provider Name | Dr. Hossein Jadvar |
First Address | Los Angeles, CA 90031-0309 |
Second Address | Los Angeles, CA 90033-5320 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2006 |
Last Update Date | 10/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H00048 | (02) | CA |