MEDICARE: DR. NADER JAVADI 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	174400000X	Specialist	H20156	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	W21577	OTHER	CA	MEDICARE GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	A67700	OTHER	CA	CA MEDICAL LICENSE

General Provider Information

NPI Number	:	1962405266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NADER JAVADI M.D.

Provider Business Mailing Address
First Line	:	24100 CALABASAS RD STE 100
Second Line	:
City	:	CALABASAS
State	:	CA
Zip	:	91302-1636
Country	:	US
Telephone Number	:	818-578-6454
Fax Number	:	818-578-6571

Provider Business Practice Location Address
First Line	:	24100 CALABASAS RD STE 100
Second Line	:
City	:	CALABASAS
State	:	CA
Zip	:	91302-1636
Country	:	US
Telephone Number	:	818-578-6454
Fax Number	:	818-578-6571

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	12/03/2018

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Directions to “ DR. NADER JAVADI M.D.” Practice Location

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