Healthcare Provider Details

I. General information

NPI: 1992563944
Provider Name (Legal Business Name): SARA JAVIDINEJAD O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2024
Last Update Date: 02/02/2026
Certification Date: 02/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5991 E SPRING ST
LONG BEACH CA
90808-3752
US

IV. Provider business mailing address

121 W WHITTIER BLVD STE 100
LA HABRA CA
90631-0903
US

V. Phone/Fax

Practice location:
  • Phone: 562-938-9945
  • Fax:
Mailing address:
  • Phone: 562-694-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number35773
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: