Provider Demographics
NPI:1477625945
Name:BADALIAN, VAHE (MD)
Entity Type:Individual
Prefix:DR
First Name:VAHE
Middle Name:
Last Name:BADALIAN
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 1:1530 E CHEVY CHASE DR STE 201
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4139
Mailing Address - Country:US
Mailing Address - Phone:818-247-9200
Mailing Address - Fax:818-484-8190
Practice Address - Street 1:1530 E CHEVY CHASE DR STE 201
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206
Practice Address - Country:US
Practice Address - Phone:818-247-9200
Practice Address - Fax:818-484-8190
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45222207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A452220Medicaid
CAA45222Medicare ID - Type Unspecified
CA00A452220Medicaid