Provider Demographics
NPI:1548523657
Name:HAJ, CALDON (MD)
Entity type:Individual
Prefix:DR
First Name:CALDON
Middle Name:
Last Name:HAJ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KHALDOUN
Other - Middle Name:
Other - Last Name:HAJ MAHMOUD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4231 BALBOA AVE # 3009
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-5504
Mailing Address - Country:US
Mailing Address - Phone:773-828-4310
Mailing Address - Fax:888-959-3942
Practice Address - Street 1:4052 RAFFEE DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-4427
Practice Address - Country:US
Practice Address - Phone:773-828-4310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-22
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-38083207R00000X
CAA153365207R00000X
MA277622207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine