Provider Demographics
NPI:1700368479
Name:MOHEBAN, BAHAR (PSYD)
Entity Type:Individual
Prefix:
First Name:BAHAR
Middle Name:
Last Name:MOHEBAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5665 WILSHIRE BLVD # 1033
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-3710
Mailing Address - Country:US
Mailing Address - Phone:707-872-7727
Mailing Address - Fax:
Practice Address - Street 1:5665 WILSHIRE BLVD # 1033
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-3710
Practice Address - Country:US
Practice Address - Phone:707-872-7727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-29
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY32421103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical