MEDICARE: DR. RON JAVDAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	R8435	MO
2	207RC0000X	Cardiovascular Disease Physician	C50454	CA

General Provider Information

NPI Number	:	1093878258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RON JAVDAN M.D.

Provider Business Mailing Address
First Line	:	6 JUNGERMANN CIR
Second Line	:	SUITE 203
City	:	SAINT PETERS
State	:	MO
Zip	:	63376-1621
Country	:	US
Telephone Number	:	636-928-1822
Fax Number	:	636-441-7033

Provider Business Practice Location Address
First Line	:	3631 CRENSHAW BLVD STE 109
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90016-4869
Country	:	US
Telephone Number	:	323-732-0100
Fax Number	:	323-732-0104

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	04/22/2025

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