=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316963713
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AFSHIN BAHADOR MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/15/2006
-----------------------------------------------------
Last Update Date | 03/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9095 RIO SAN DIEGO DR STE 425
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92108-1679
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-455-5524
-----------------------------------------------------
Fax | 858-587-9377
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5030 CAMINO DE LA SIESTA STE 202
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92108-3118
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-455-5524
-----------------------------------------------------
Fax | 858-587-9377
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2086X0206X
-----------------------------------------------------
Taxonomy Name | Surgical Oncology Physician
-----------------------------------------------------
License Number | A65396
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | A65396
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------