=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699949404
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMIR H. BAHADORI, M.D., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/14/2008
-----------------------------------------------------
Last Update Date | 11/16/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4955 VAN NUYS BLVD SUITE 405
-----------------------------------------------------
City | SHERMAN OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-995-8240
-----------------------------------------------------
Fax | 818-995-8260
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4955 VAN NUYS BLVD SUITE 405
-----------------------------------------------------
City | SHERMAN OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-995-8240
-----------------------------------------------------
Fax | 818-995-8260
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | MR. AMIR HOSSEIN BAHADORI
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 818-995-8240
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | A65627
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------