NPIMap

Organization Active NPI

Imad S. Dandan, M.D.

  • Trauma Surgery Physician
  • La Jolla, CA
National Provider Identifier
1679752786
Registry record updated Oct 25, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Trauma Surgery PhysicianTaxonomy code 2086S0127X
License
A45893 Issued in CA
Legal business name
IMAD S. DANDAN, M.D.
Practice address
9888 Genesee Ave
LJ-601
La Jolla, CA 92037-1205
Phone
(858) 626-6362
Fax
(858) 626-6354
NPI assigned
Oct 25, 2007
Last updated
Oct 25, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2007

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

Authorized official

Name
Imad S. Dandan, M.D.NPI 1982708384
Title
Director, Manager
Phone
(858) 626-6362

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Trauma Surgery Physician 2086S0127X A45893 CA Primary

Addresses

Primary practice location

9888 Genesee Ave
LJ-601
La Jolla, CA 92037-1205

Mailing address

9888 Genesee Ave
LJ-601
La Jolla, CA 92037-1205
Phone (858) 626-6362

Other identifiers 2

IdentifierTypeStateIssuer
00A458930OtherCABLUE SHIELD
00A458930MedicaidCA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1193270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193270400000",
    "number": "1679752786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9888 GENESEE AVE",
            "address_2": "LJ-601",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920371205",
            "telephone_number": "858-626-6362",
            "fax_number": "858-626-6354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9888 GENESEE AVE",
            "address_2": "LJ-601",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920371205",
            "telephone_number": "858-626-6362",
            "fax_number": "858-626-6354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMAD S. DANDAN, M.D.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-25",
        "last_updated": "2007-10-25",
        "status": "A",
        "authorized_official_last_name": "DANDAN",
        "authorized_official_first_name": "IMAD",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "DIRECTOR, MANAGER",
        "authorized_official_telephone_number": "858-626-6362",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2086S0127X",
            "taxonomy_group": "",
            "desc": "Surgery, Trauma Surgery",
            "state": "CA",
            "license": "A45893",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "00A458930",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A458930",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in La Jolla, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.