Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | A140110 | CA |
NPI | 1104269729 |
---|---|
Provider Name | Dr. Shadfar Bahri |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Los Angeles, CA 90095-5201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2013 |
Last Update Date | 17/03/2018 |