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General NPI Number Information
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NPI Number | 1598033920
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Entity Type | Organization
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Legal Business Name | JACKLIN POLADIAN, M.D., INC.
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Dates
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Enumeration Date | 12/13/2011
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Last Update Date | 10/27/2023
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Provider Practice Location Address
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Address Line | 800 FAIRMOUNT AVE STE 420
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City | PASADENA
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State | CA
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Zip | 91105-3154
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Country | US
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Telephone | 626-200-4500
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Fax | 626-795-0704
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Provider Business Mailing Address
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Address Line | 301 S FAIR OAKS AVE SUITE 403
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City | PASADENA
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State | CA
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Zip | 91105-2561
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Country | US
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Telephone | 626-200-4500
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Fax | 626-795-0704
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DR. JACKLIN POLADIAN
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Credential | M.D.
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Telephone | 626-200-4500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | A110327
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License Number State | CA
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