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Individual
FRED JAVDAN
Active
Individual
FRED JAVDAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
A76858
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A76858
MEDICARE PTAN
CA
Enumeration date
09/07/2006
Last updated
04/30/2018
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