Provider Demographics
NPI:1114939022
Name:BAQAI, SALAHUD-DIN AHMAD (MD)
Entity Type:Individual
Prefix:
First Name:SALAHUD-DIN
Middle Name:AHMAD
Last Name:BAQAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4440 BROCKTON AVE
Mailing Address - Street 2:STE. 430
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-4068
Mailing Address - Country:US
Mailing Address - Phone:951-683-5380
Mailing Address - Fax:951-683-2734
Practice Address - Street 1:4440 BROCKTON AVE
Practice Address - Street 2:STE. 430
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-4068
Practice Address - Country:US
Practice Address - Phone:951-683-5380
Practice Address - Fax:951-683-2734
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2016-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35119208000000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF18990Medicare UPIN