Healthcare Provider Details

I. General information

NPI: 1578577813
Provider Name (Legal Business Name): NAJI KANDALAFT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 03/06/2020
Certification Date: 03/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 W CARROLL AVE STE 204
GLENDORA CA
91741-4240
US

IV. Provider business mailing address

412 W CARROLL AVE STE 204
GLENDORA CA
91741-4240
US

V. Phone/Fax

Practice location:
  • Phone: 626-852-8873
  • Fax: 626-852-8874
Mailing address:
  • Phone: 626-852-8873
  • Fax: 626-852-8874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA46044
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA46044
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberA46044
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License NumberA46044
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: