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General NPI Number Information
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NPI Number | 1962573311
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Entity Type | Organization
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Legal Business Name | BAHAREH B KHAVARIAN MD INC
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 27725 SANTA MARGARITA PKWY SUITE 108
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City | MISSION VIEJO
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State | CA
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Zip | 92691-6704
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Country | US
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Telephone | 949-916-8770
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Fax | 949-916-8769
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Provider Business Mailing Address
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Address Line | 27725 SANTA MARGARITA PKWY SUITE 108
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City | MISSION VIEJO
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State | CA
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Zip | 92691-6704
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Country | US
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Telephone | 949-916-8770
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Fax | 949-916-8769
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BAHAREH BAHADORI KHAVARIAN
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Credential | MD
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Telephone | 949-916-8770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A79841
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License Number State | CA
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