Healthcare Provider Details

I. General information

NPI: 1235662255
Provider Name (Legal Business Name): KIARASH BAKHAJ D.P.M
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 S BEACH BLVD STE 102
ANAHEIM CA
92804-1868
US

IV. Provider business mailing address

408 S BEACH BLVD STE 102
ANAHEIM CA
92804-1868
US

V. Phone/Fax

Practice location:
  • Phone: 714-204-8766
  • Fax:
Mailing address:
  • Phone: 714-204-8766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE5636
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: