Healthcare Provider Details

I. General information

NPI: 1659515252
Provider Name (Legal Business Name): MERCEDEH BAGHAI M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2009
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 N PROSPECT AVE STE 115
REDONDO BEACH CA
90277-3057
US

IV. Provider business mailing address

21143 HAWTHORNE BLVD # 416
TORRANCE CA
90503-4615
US

V. Phone/Fax

Practice location:
  • Phone: 310-602-5002
  • Fax: 310-325-9105
Mailing address:
  • Phone: 310-602-5002
  • Fax: 310-325-9105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA94732
License Number StateCA

VIII. Authorized Official

Name: DR. MERCEDEH BAGHAI
Title or Position: OWNER
Credential: MD
Phone: 310-602-5002