Provider Demographics
NPI:1982829800
Name:KAVEH BAGHERI, MD INCORPORATED
Entity Type:Organization
Organization Name:KAVEH BAGHERI, MD INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAVEH
Authorized Official - Middle Name:
Authorized Official - Last Name:BAGHERI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-589-2535
Mailing Address - Street 1:PO BOX 2250
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91943-2250
Mailing Address - Country:US
Mailing Address - Phone:619-589-2535
Mailing Address - Fax:619-589-8042
Practice Address - Street 1:8860 CENTER DR
Practice Address - Street 2:SUITE 240
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-7000
Practice Address - Country:US
Practice Address - Phone:619-589-2535
Practice Address - Fax:619-589-8042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52496174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty