Healthcare Provider Details

I. General information

NPI: 1316963713
Provider Name (Legal Business Name): AFSHIN BAHADOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9095 RIO SAN DIEGO DR STE 425
SAN DIEGO CA
92108-1679
US

IV. Provider business mailing address

5030 CAMINO DE LA SIESTA STE 202
SAN DIEGO CA
92108-3118
US

V. Phone/Fax

Practice location:
  • Phone: 858-455-5524
  • Fax: 858-587-9377
Mailing address:
  • Phone: 858-455-5524
  • Fax: 858-587-9377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberA65396
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA65396
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: