Healthcare Provider Details

I. General information

NPI: 1801433651
Provider Name (Legal Business Name): HAIG JOHN DADAIAN DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2019
Last Update Date: 11/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18411 CLARK ST STE 302
TARZANA CA
91356-3541
US

IV. Provider business mailing address

3379 ALGINET DR
ENCINO CA
91436-4121
US

V. Phone/Fax

Practice location:
  • Phone: 818-501-7276
  • Fax:
Mailing address:
  • Phone: 818-644-3460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number141887822
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: