Provider Demographics
NPI:1932217056
Name:BAHL, SUSHMA (MD)
Entity Type:Individual
Prefix:MRS
First Name:SUSHMA
Middle Name:
Last Name:BAHL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21671 GATEWAY CENTER DR
Mailing Address - Street 2:SUITE #101
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-2461
Mailing Address - Country:US
Mailing Address - Phone:909-833-0787
Mailing Address - Fax:
Practice Address - Street 1:21671 GATEWAY CENTER DR
Practice Address - Street 2:SUITE #101
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-2461
Practice Address - Country:US
Practice Address - Phone:909-396-9100
Practice Address - Fax:909-396-9130
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45671208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice