Provider Demographics
NPI:1073619789
Name:BAGHERI, ABES SEYYED (MD)
Entity Type:Individual
Prefix:DR
First Name:ABES
Middle Name:SEYYED
Last Name:BAGHERI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3801 KATELLA AVE
Mailing Address - Street 2:210
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3338
Mailing Address - Country:US
Mailing Address - Phone:562-431-1918
Mailing Address - Fax:562-431-2423
Practice Address - Street 1:3801 KATELLA AVE
Practice Address - Street 2:210
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3338
Practice Address - Country:US
Practice Address - Phone:562-431-1918
Practice Address - Fax:562-431-2423
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA308892084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA30889Medicare PIN
CAA87471Medicare UPIN