Provider Demographics
NPI:1821013046
Name:RAD, BABAK N (MD)
Entity Type:Individual
Prefix:DR
First Name:BABAK
Middle Name:N
Last Name:RAD
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Gender:M
Credentials:MD
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Mailing Address - Street 1:510 SUPERIOR AVE
Mailing Address - Street 2:SUITE 200-G
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3663
Mailing Address - Country:US
Mailing Address - Phone:949-791-6767
Mailing Address - Fax:949-791-6768
Practice Address - Street 1:510 SUPERIOR AVE
Practice Address - Street 2:SUITE 200-G
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3663
Practice Address - Country:US
Practice Address - Phone:949-791-6767
Practice Address - Fax:949-791-6768
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2014-10-23
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Provider Licenses
StateLicense IDTaxonomies
CAA71407208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA71407BMedicare PIN
CAH36841Medicare UPIN