Provider Demographics
NPI:1174920771
Name:IDA JAHED, MD, INC.
Entity type:Organization
Organization Name:IDA JAHED, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:IDA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAHED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-386-7221
Mailing Address - Street 1:3908 MILLBROOK DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-7613
Mailing Address - Country:US
Mailing Address - Phone:216-386-7221
Mailing Address - Fax:
Practice Address - Street 1:5555 MONTGOMERY DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-8846
Practice Address - Country:US
Practice Address - Phone:707-538-8400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty