Provider Demographics
NPI:1487297016
Name:BIDAR, SAJJAD
Entity type:Individual
Prefix:
First Name:SAJJAD
Middle Name:
Last Name:BIDAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3838 CLAYTON RD APT 203
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521-2564
Mailing Address - Country:US
Mailing Address - Phone:925-325-2028
Mailing Address - Fax:
Practice Address - Street 1:3838 CLAYTON RD APT 203
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94521-2564
Practice Address - Country:US
Practice Address - Phone:925-325-2028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-27
Last Update Date:2019-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program