Healthcare Provider Details

I. General information

NPI: 1982829800
Provider Name (Legal Business Name): KAVEH BAGHERI, MD INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 10/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8860 CENTER DR SUITE 240
LA MESA CA
91942-7000
US

IV. Provider business mailing address

PO BOX 2250
LA MESA CA
91943-2250
US

V. Phone/Fax

Practice location:
  • Phone: 619-589-2535
  • Fax: 619-589-8042
Mailing address:
  • Phone: 619-589-2535
  • Fax: 619-589-8042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA52496
License Number StateCA

VIII. Authorized Official

Name: KAVEH BAGHERI
Title or Position: OWNER
Credential: MD
Phone: 619-589-2535