Provider Demographics
NPI:1417274952
Name:BAHAR MEDICAL GROUP INC
Entity Type:Organization
Organization Name:BAHAR MEDICAL GROUP INC
Other - Org Name:VITAL PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALIREZA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAZAEIZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-394-6175
Mailing Address - Street 1:2507 EASTBLUFF DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-3504
Mailing Address - Country:US
Mailing Address - Phone:949-600-7733
Mailing Address - Fax:949-600-8822
Practice Address - Street 1:2507 EASTBLUFF DR
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-3504
Practice Address - Country:US
Practice Address - Phone:949-600-7733
Practice Address - Fax:949-600-8822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-23
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA100885174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADK868AMedicare PIN