Provider Demographics
NPI:1841208964
Name:GHATAN, BIJAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BIJAN
Middle Name:
Last Name:GHATAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20401 AVALON BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-3226
Mailing Address - Country:US
Mailing Address - Phone:310-327-8877
Mailing Address - Fax:310-217-1828
Practice Address - Street 1:20401 AVALON BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-3226
Practice Address - Country:US
Practice Address - Phone:310-327-8877
Practice Address - Fax:310-217-1828
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA44085207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE36678Medicare UPIN