Healthcare Provider Details

I. General information

NPI: 1740919596
Provider Name (Legal Business Name): DR. YASAMAN JAVDAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 W VALLEY PKWY
ESCONDIDO CA
92025-2635
US

IV. Provider business mailing address

390 W VALLEY PKWY
ESCONDIDO CA
92025-2635
US

V. Phone/Fax

Practice location:
  • Phone: 619-854-4576
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number109993
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: