Provider Demographics
NPI:1518992585
Name:BAHADORI, AMIR HOSSEIN (MD)
Entity Type:Individual
Prefix:MR
First Name:AMIR
Middle Name:HOSSEIN
Last Name:BAHADORI
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 1:4955 VAN NUYS BLVD
Mailing Address - Street 2:SUITE 405
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403
Mailing Address - Country:US
Mailing Address - Phone:818-995-8240
Mailing Address - Fax:818-995-8260
Practice Address - Street 1:4955 VAN NUYS BLVD
Practice Address - Street 2:SUITE 405
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403
Practice Address - Country:US
Practice Address - Phone:818-995-8240
Practice Address - Fax:818-995-8260
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA65627173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A656270Medicaid
CAH23806Medicare UPIN
CA00A656270Medicaid