Provider Demographics
NPI:1144431941
Name:SAJJADI, MARK (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:SAJJADI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 N 14TH ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112
Mailing Address - Country:US
Mailing Address - Phone:408-294-1825
Mailing Address - Fax:408-294-1826
Practice Address - Street 1:93 N 14TH ST
Practice Address - Street 2:SUITE 3
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112
Practice Address - Country:US
Practice Address - Phone:408-294-1825
Practice Address - Fax:408-294-1826
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC18399207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C183990OtherPROVIDER NUMBER
9930317Medicare UPIN