Healthcare Provider Details

I. General information

NPI: 1376595314
Provider Name (Legal Business Name): KEYVAN BAHADI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 SAMARITAN DR
SAN JOSE CA
95124-3908
US

IV. Provider business mailing address

1484 POLLARD RD PMB 305
LOS GATOS CA
95032-1031
US

V. Phone/Fax

Practice location:
  • Phone: 408-559-2011
  • Fax:
Mailing address:
  • Phone: 408-358-8665
  • Fax: 408-358-8605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA31245
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: