MEDICARE: DR. SHAHIN BAGHERI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RR0500X	Rheumatology Physician	34357	IA
2	207RR0500X	Rheumatology Physician	A77192	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	35155	OTHER	IA	BLUE CROSS/BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457359978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHAHIN BAGHERI MD

Provider Business Mailing Address
First Line	:	8510 BALBOA BLVD
Second Line	:	STE 150
City	:	NORTHRIDGE
State	:	CA
Zip	:	91325-5810
Country	:	US
Telephone Number	:	818-654-3400
Fax Number	:	818-654-3417

Provider Business Practice Location Address
First Line	:	191 S BUENA VISTA ST.
Second Line	:	STE 420
City	:	BURBANK
State	:	CA
Zip	:	91505-4551
Country	:	US
Telephone Number	:	818-557-7399
Fax Number	:	818-848-1543

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	07/19/2024

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