Provider Demographics
NPI:1023134210
Name:RON BAHAR, MD, A MEDICAL CORPORATION
Entity type:Organization
Organization Name:RON BAHAR, MD, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:RON
Authorized Official - Middle Name:JONATHAN
Authorized Official - Last Name:BAHAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-905-6600
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric GastroenterologyGroup - Single Specialty