Provider Demographics
NPI:1255480661
Name:CHAVOSHAN, BAHMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BAHMAN
Middle Name:
Last Name:CHAVOSHAN
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 1:1050 LINDEN AVE
Mailing Address - Street 2:GME THIRD FLOOR
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-3321
Mailing Address - Country:US
Mailing Address - Phone:562-491-9354
Mailing Address - Fax:562-491-9146
Practice Address - Street 1:1050 LINDEN AVE
Practice Address - Street 2:GME THIRD FLOOR
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3321
Practice Address - Country:US
Practice Address - Phone:562-491-9354
Practice Address - Fax:562-491-9146
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2015-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG85367207R00000X, 207RC0200X, 207RP1001X, 207RS0012X
TXJ6375207R00000X
CAG0853672083A0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G853670Medicaid
CA00G853670Medicaid
CA00G853671Medicare PIN