Organization
IMAD S. DANDAN, M.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IMAD S. DANDAN M.D. (DIRECTOR, MANAGER)
(858) 626-6362
Entity
Organization
Contact information
Practice address
9888 GENESEE AVE, LJ-601, LA JOLLA, CA 92037-1205
(858) 626-6362
(858) 626-6354
Mailing address
9888 GENESEE AVE, LJ-601, LA JOLLA, CA 92037-1205
(858) 626-6362
(858) 626-6354
Taxonomy
Speciality
Code
Description
License number
State
2086S0127X
Trauma Surgery Physician
Primary
A45893
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A458930
BLUE SHIELD
CA
05
—
00A458930
—
CA
Enumeration date
10/25/2007
Last updated
10/25/2007
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