Provider Demographics
NPI:1265537906
Name:BAHARVAR, JAMES JAMSHID (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:JAMSHID
Last Name:BAHARVAR
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2428 SANTA MONICA BLVD
Mailing Address - Street 2:STE 404
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2047
Mailing Address - Country:US
Mailing Address - Phone:310-828-6868
Mailing Address - Fax:310-828-9597
Practice Address - Street 1:2428 SANTA MONICA BLVD
Practice Address - Street 2:STE 404
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2047
Practice Address - Country:US
Practice Address - Phone:310-828-6868
Practice Address - Fax:310-828-9597
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA34541207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOA345410Medicaid
CAOOA345410Medicaid
A27507Medicare UPIN