Organization Active NPI

Javidan Urology, Inc

  • Urology Physician
  • Roseville, CA
National Provider Identifier
1174043129
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
A83658 Issued in CA
Legal business name
JAVIDAN UROLOGY, INC
Practice address
729 Sunrise Ave Ste 200
Roseville, CA 95661-4504
Phone
(916) 245-2444
Fax
(916) 245-2441
NPI assigned
Jun 21, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sveta Aslanyan
Title
Manager
Phone
(916) 947-0967

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208800000X A83658 CA Primary

Addresses

Primary practice location

729 Sunrise Ave Ste 200
Roseville, CA 95661-4504

Mailing address

729 Sunrise Ave Ste 200
Roseville, CA 95661-4504
Phone (916) 245-2444

Other identifiers 1

IdentifierTypeStateIssuer
1679558605MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170830000801 CA Part B Supplier - Clinic/Group Practice 5496028201 Receives reassigned benefits from 7 practitioners
Practice locations: Carmichael, CA

National Provider Directory

National Provider Directory

Locations

2360 E Bidwell St
Folsom, CA 95630

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1498003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1174043129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "729 SUNRISE AVE STE 200",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956614504",
            "telephone_number": "916-245-2444",
            "fax_number": "916-245-2441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "729 SUNRISE AVE STE 200",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956614504",
            "telephone_number": "916-245-2444",
            "fax_number": "916-245-2441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAVIDAN UROLOGY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-21",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "ASLANYAN",
        "authorized_official_first_name": "SVETA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "916-947-0967"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": "CA",
            "license": "A83658",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1679558605",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseville, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.