Provider Demographics
NPI:1750479002
Name:BAHAR, RON JONATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:RON
Middle Name:JONATHAN
Last Name:BAHAR
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:5363 BALBOA BLVD
Mailing Address - Street 2:SUITE 540
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-2805
Mailing Address - Country:US
Mailing Address - Phone:818-905-6600
Mailing Address - Fax:818-905-6610
Practice Address - Street 1:5363 BALBOA BLVD
Practice Address - Street 2:SUITE 540
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-2805
Practice Address - Country:US
Practice Address - Phone:818-905-6600
Practice Address - Fax:818-905-6610
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA521952080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG54409Medicare UPIN