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General NPI Number Information
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NPI Number | 1174920771
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Entity Type | Organization
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Legal Business Name | IDA JAHED, MD, INC.
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Dates
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Enumeration Date | 11/25/2014
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Last Update Date | 11/25/2014
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Provider Practice Location Address
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Address Line | 5555 MONTGOMERY DR
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City | SANTA ROSA
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State | CA
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Zip | 95409-8846
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Country | US
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Telephone | 707-538-8400
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Fax |
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Provider Business Mailing Address
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Address Line | 3908 MILLBROOK DR
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City | SANTA ROSA
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State | CA
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Zip | 95404-7613
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Country | US
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Telephone | 216-386-7221
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Fax |
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Authorized Official
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Title or Position | SOLE MANAGER
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Name | IDA JAHED
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Credential | MD
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Telephone | 216-386-7221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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