Healthcare Provider Details

I. General information

NPI: 1720032808
Provider Name (Legal Business Name): OMID HAJISEYEDJAVADI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: OMID JAVADI MD

II. Dates (important events)

Enumeration Date: 05/21/2006
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

485 S DOBSON RD STE 203
CHANDLER AZ
85224-5604
US

IV. Provider business mailing address

16696 CYPRESS WAY
LOS GATOS CA
95030-7531
US

V. Phone/Fax

Practice location:
  • Phone: 480-728-2690
  • Fax: 480-728-2689
Mailing address:
  • Phone: 408-896-9450
  • Fax: 408-213-7621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number24220
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number04-51786
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberME180845
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME180845
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberC55150
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number44129
License Number StateKY
# 7
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number01099305A
License Number StateIN
# 8
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number101490
License Number StateWI
# 9
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number036.130433
License Number StateIL
# 10
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number165090
License Number StateMT
# 11
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number35210
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: