Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | A168885 | CA |
N | 207X00000X | Orthopaedic Surgeon | D87120 | MD |
Y | 207XS0117X | Orthopaedic Spine Surgeon | A168885 | CA |
NPI | 1225476500 |
---|---|
Provider Name | Bayan Aghdasi |
First Address | Sacramento, CA 95865-5228 |
Second Address | Stockton, CA 95209-2839 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2013 |
Last Update Date | 11/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D87120 | LICENSE (01) | MD |