MEDICARE: KIARASH BAKHAJ INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist

General Provider Information

NPI Number	:	1093577496
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIARASH BAKHAJ INC

Provider Business Mailing Address
First Line	:	408 S BEACH BLVD STE 102
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92804-1868
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	408 S BEACH BLVD STE 102
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92804-1868
Country	:	US
Telephone Number	:	714-204-8766
Fax Number	:

Authorized Official
Title or Position	:	OWNER, AUTHORIZED OFFICIAL
Name	:	KIARASH BAKHAJ
Credential	:	DPM
Telephone Number	:	714-204-8766

Provider Enumeration Date	:	01/30/2024
Last Update Date	:	01/30/2024

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Directions to “KIARASH BAKHAJ INC ” Practice Location

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