Provider Demographics
NPI:1114124989
Name:FATHI, BAHAREH (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:BAHAREH
Middle Name:
Last Name:FATHI
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 PASO ALTO DR
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-1134
Mailing Address - Country:US
Mailing Address - Phone:818-207-1490
Mailing Address - Fax:
Practice Address - Street 1:4366 TUJUNGA AVE
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2751
Practice Address - Country:US
Practice Address - Phone:818-985-5462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA539051223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics