Provider Demographics
NPI:1275738346
Name:BAHL, RAJAN (MD)
Entity Type:Individual
Prefix:
First Name:RAJAN
Middle Name:
Last Name:BAHL
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 1:333 WASHINGTON BLVD
Mailing Address - Street 2:#476
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5152
Mailing Address - Country:US
Mailing Address - Phone:415-857-5202
Mailing Address - Fax:
Practice Address - Street 1:333 WASHINGTON BLVD
Practice Address - Street 2:#476
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-5152
Practice Address - Country:US
Practice Address - Phone:415-857-5202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1162592084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry