Provider Demographics
NPI:1104356120
Name:BAHR, ALDEN
Entity Type:Individual
Prefix:
First Name:ALDEN
Middle Name:
Last Name:BAHR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 EL CAMINO REAL STE 225
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-3230
Mailing Address - Country:US
Mailing Address - Phone:650-697-3200
Mailing Address - Fax:
Practice Address - Street 1:1720 EL CAMINO REAL STE 225
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3230
Practice Address - Country:US
Practice Address - Phone:650-697-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101272725207W00000X, 208D00000X
CAA186484208D00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice