Provider Demographics
NPI:1811944069
Name:RAHAVI, BEHZAD BURT (MD)
Entity type:Individual
Prefix:
First Name:BEHZAD
Middle Name:BURT
Last Name:RAHAVI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 NEWPORT CENTER DR
Mailing Address - Street 2:SUITE # 602-A
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7601
Mailing Address - Country:US
Mailing Address - Phone:949-759-9110
Mailing Address - Fax:949-759-9118
Practice Address - Street 1:400 NEWPORT CENTER DR
Practice Address - Street 2:SUITE # 602-A
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7601
Practice Address - Country:US
Practice Address - Phone:949-759-9110
Practice Address - Fax:949-759-9118
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38622207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACO2374Medicare UPIN
A38622AMedicare ID - Type Unspecified