Healthcare Provider Details

I. General information

NPI: 1275929895
Provider Name (Legal Business Name): RIHAN JAVID D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2015
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 N CALIFORNIA ST STE 201
STOCKTON CA
95204-6032
US

IV. Provider business mailing address

1805 N CALIFORNIA ST STE 201
STOCKTON CA
95204-6032
US

V. Phone/Fax

Practice location:
  • Phone: 209-645-4005
  • Fax: 209-645-6344
Mailing address:
  • Phone: 209-645-4005
  • Fax: 209-645-6344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20A16536
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: