MEDICARE: KIARASH BAKHAJ D.P.M

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	213ES0103X	Foot & Ankle Surgery Podiatrist	E5636	CA

General Provider Information

NPI Number	:	1235662255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIARASH BAKHAJ D.P.M

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	:	714-204-8766
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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2017
Last Update Date	:	04/16/2026

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