Healthcare Provider Details

I. General information

NPI: 1205849445
Provider Name (Legal Business Name): YASHODEEP P JADHAV M.D.,M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 UTAH AVE
EL SEGUNDO CA
90245-4817
US

IV. Provider business mailing address

2330 UTAH AVE
EL SEGUNDO CA
90245-4817
US

V. Phone/Fax

Practice location:
  • Phone: 570-213-5571
  • Fax:
Mailing address:
  • Phone: 570-213-5571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME110802
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: