# JAVID GHANDEHARI, MD, A CALIFORNIA MEDICAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184192049
- **Authorized official:** JAVID GHANDEHARI MD (OWNER)
- **Authorized official phone:** (210) 845-6268

## Contact information

- **Practice address:** 1328 22ND ST, SANTA MONICA, CA 90404-2032
- **Practice address phone:** (310) 829-5511
- **Mailing address:** 150 W CIVIC CENTER DR STE 200, SANDY, UT 84070-4284
- **Mailing address phone:** (888) 854-3822
- **Mailing address fax:** (770) 701-6673

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | NULL | — |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | — | — |
| 208VP0000X | Pain Medicine Physician | — | NULL | Yes |
| 208VP0000X | Pain Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/08/2018
- **Last updated:** 11/08/2018