Healthcare Provider Details

I. General information

NPI: 1801944277
Provider Name (Legal Business Name): MEHRAN BAHERI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1257 BROCKTON AVE PH 3
LOS ANGELES CA
90025-7727
US

IV. Provider business mailing address

1257 BROCKTON AVE PH 3
LOS ANGELES CA
90025-7727
US

V. Phone/Fax

Practice location:
  • Phone: 310-210-1039
  • Fax:
Mailing address:
  • Phone: 310-210-1039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA87581
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA87581
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: