Healthcare Provider Details

I. General information

NPI: 1659558492
Provider Name (Legal Business Name): FREDERIC BAKHCHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2008
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18370 BURBANK BLVD STE 307
TARZANA CA
91356-2850
US

IV. Provider business mailing address

170 WILLIAM ST 4TH FLOOR
NEW YORK NY
10038-2612
US

V. Phone/Fax

Practice location:
  • Phone: 818-996-6000
  • Fax: 818-996-4712
Mailing address:
  • Phone: 212-312-5761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC141416
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number244842
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: