Provider Demographics
NPI:1760438725
Name:BABAK BARADAR-BOKAIE MD INC
Entity Type:Organization
Organization Name:BABAK BARADAR-BOKAIE MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:BABAK
Authorized Official - Middle Name:
Authorized Official - Last Name:BARADAR-BOKAIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-672-9000
Mailing Address - Street 1:511 EAST MANCHESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-1907
Mailing Address - Country:US
Mailing Address - Phone:610-672-9000
Mailing Address - Fax:310-672-9030
Practice Address - Street 1:511 EAST MANCHESTER BLVD
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-1907
Practice Address - Country:US
Practice Address - Phone:310-672-9000
Practice Address - Fax:310-672-9030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA85378207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19756Medicare ID - Type Unspecified
O387836Medicare UPIN