NPIMap

Organization Active NPI

Jacklin Poladian, M.D., Inc.

  • Primary Care Clinic/Center
  • Pasadena, CA
National Provider Identifier
1598033920
Registry record updated Oct 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
A110327 Issued in CA
Legal business name
JACKLIN POLADIAN, M.D., INC.
Practice address
800 Fairmount Ave Ste 420
Pasadena, CA 91105-3154
Phone
(626) 200-4500
Fax
(626) 795-0704
NPI assigned
Dec 13, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2023

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

Authorized official

Name
Dr. Jacklin Poladian, M.D.NPI 1629239892
Title
Chief Executive Officer
Phone
(626) 200-4500

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X A110327 CA Primary

Addresses

Primary practice location

800 Fairmount Ave Ste 420
Pasadena, CA 91105-3154

Mailing address

301 S Fair Oaks Ave
Suite 403
Pasadena, CA 91105-2561
Phone (626) 200-4500

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120224000504 CA Part B Supplier - Clinic/Group Practice 0446418222 Receives reassigned benefits from 1 practitioner
Practice locations: Pasadena, CA

National Provider Directory

National Provider Directory

Locations

301 S Fair Oaks Ave
Ste 403
Pasadena, CA 91105
Phone (626) 200-4500

Practitioners & affiliated clinicians

Practitioners 4

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": "1323734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698364800000",
    "number": "1598033920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 S FAIR OAKS AVE",
            "address_2": "SUITE 403",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911052561",
            "telephone_number": "626-200-4500",
            "fax_number": "626-795-0704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 FAIRMOUNT AVE STE 420",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911053154",
            "telephone_number": "626-200-4500",
            "fax_number": "626-795-0704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKLIN POLADIAN, M.D., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-13",
        "last_updated": "2023-10-27",
        "certification_date": "2023-10-27",
        "status": "A",
        "authorized_official_last_name": "POLADIAN",
        "authorized_official_first_name": "JACKLIN",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "626-200-4500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "CA",
            "license": "A110327",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pasadena, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2023; 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.