Provider Demographics
NPI:1518345453
Name:KACHOUEI, BEHNAM (DO)
Entity Type:Individual
Prefix:
First Name:BEHNAM
Middle Name:
Last Name:KACHOUEI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 E TAM O SHANTER ST
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-6455
Mailing Address - Country:US
Mailing Address - Phone:909-638-4045
Mailing Address - Fax:
Practice Address - Street 1:555 E TACHEVAH DR STE 2E204
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-5737
Practice Address - Country:US
Practice Address - Phone:760-561-7344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-12
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A17361174400000X, 208000000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No174400000XOther Service ProvidersSpecialist
No208000000XAllopathic & Osteopathic PhysiciansPediatrics