MEDICARE: DR. BAHAREH BAHADORI KHAVARIAN M.D.

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	207R00000X	Internal Medicine Physician	A79841	CA

General Provider Information

NPI Number	:	1780620328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BAHAREH BAHADORI KHAVARIAN M.D.

Provider Business Mailing Address
First Line	:	320 SUPERIOR AVE
Second Line	:	STE 320
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-2742
Country	:	US
Telephone Number	:	949-916-8770
Fax Number	:	949-916-8769

Provider Business Practice Location Address
First Line	:	27725 SANTA MARGARITA PKWY
Second Line	:	SUITE 108
City	:	MISSION VIEJO
State	:	CA
Zip	:	92691-6704
Country	:	US
Telephone Number	:	949-916-8770
Fax Number	:	949-916-8769

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	09/12/2016

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