Healthcare Provider Details

I. General information

NPI: 1336138296
Provider Name (Legal Business Name): NAVID HAJISEYED JAVADI D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 07/21/2020
Certification Date: 07/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5308 LAKE MURRAY BLVD STE C
LA MESA CA
91942-1334
US

IV. Provider business mailing address

9871 E SOUTH BEND DR
SCOTTSDALE AZ
85255-2537
US

V. Phone/Fax

Practice location:
  • Phone: 619-464-4411
  • Fax: 619-464-4411
Mailing address:
  • Phone: 503-503-4849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6406
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number60005
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: