Healthcare Provider Details

I. General information

NPI: 1760390819
Provider Name (Legal Business Name): BAHMAN GHANNADIAN MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9452 MEDICAL CENTER DR
LA JOLLA CA
92037-1337
US

IV. Provider business mailing address

9452 MEDICAL CENTER DR
LA JOLLA CA
92037-1337
US

V. Phone/Fax

Practice location:
  • Phone: 858-246-2360
  • Fax:
Mailing address:
  • Phone: 858-246-2360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberCPT-00036882
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: