Provider Demographics
NPI:1780620328
Name:KHAVARIAN, BAHAREH BAHADORI (MD)
Entity type:Individual
Prefix:DR
First Name:BAHAREH
Middle Name:BAHADORI
Last Name:KHAVARIAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:320 SUPERIOR AVE
Mailing Address - Street 2:STE 320
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-2742
Mailing Address - Country:US
Mailing Address - Phone:949-916-8770
Mailing Address - Fax:949-916-8769
Practice Address - Street 1:27725 SANTA MARGARITA PKWY
Practice Address - Street 2:SUITE 108
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6704
Practice Address - Country:US
Practice Address - Phone:949-916-8770
Practice Address - Fax:949-916-8769
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA79841207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH92700Medicare UPIN
CAW17106Medicare ID - Type UnspecifiedMEDICARE