Provider Demographics
NPI:1477577351
Name:AKHAVAN, RAHA (MD)
Entity Type:Individual
Prefix:
First Name:RAHA
Middle Name:
Last Name:AKHAVAN
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 1:225 S LAKE AVE
Mailing Address - Street 2:535
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-3005
Mailing Address - Country:US
Mailing Address - Phone:626-795-6596
Mailing Address - Fax:626-795-8247
Practice Address - Street 1:300 W HUNTINGTON DR
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-3402
Practice Address - Country:US
Practice Address - Phone:626-445-4441
Practice Address - Fax:626-821-6955
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69155207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A691551OtherBLUE SHIELD
CA00A691550Medicaid
CAWA69155CMedicare PIN
CAWA69155DMedicare PIN
CAA69155Medicare ID - Type Unspecified
CA00A691550Medicaid