Healthcare Provider Details

I. General information

NPI: 1518992585
Provider Name (Legal Business Name): AMIR HOSSEIN BAHADORI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4955 VAN NUYS BLVD SUITE 405
SHERMAN OAKS CA
91403
US

IV. Provider business mailing address

4955 VAN NUYS BLVD SUITE 405
SHERMAN OAKS CA
91403
US

V. Phone/Fax

Practice location:
  • Phone: 818-995-8240
  • Fax: 818-995-8260
Mailing address:
  • Phone: 818-995-8240
  • Fax: 818-995-8260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberA65627
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA65627
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: