Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | A65396 | CA |
NPI | 1316963713 |
---|---|
Provider Name | Dr. Afshin Bahador |
First Address | San Diego, CA 92121-1002 |
Second Address | San Diego, CA 92121-1002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2006 |
Last Update Date | 22/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
004653960 | (05) | CA |
113908 | (02) | CA |