Provider Demographics
NPI:1316060098
Name:ZADEH, JAFAR KAYDASHTI (PA)
Entity type:Individual
Prefix:MR
First Name:JAFAR
Middle Name:KAYDASHTI
Last Name:ZADEH
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 MCCAULEY LN
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-1171
Mailing Address - Country:US
Mailing Address - Phone:858-354-0233
Mailing Address - Fax:
Practice Address - Street 1:3772 MISSION AVE
Practice Address - Street 2:SUITE 122
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058-1453
Practice Address - Country:US
Practice Address - Phone:760-630-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 16473363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant