Provider Demographics
NPI:1124148713
Name:NEHAWANDIAN, BAHAR (DC)
Entity type:Individual
Prefix:DR
First Name:BAHAR
Middle Name:
Last Name:NEHAWANDIAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3151 OLIN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117-1635
Mailing Address - Country:US
Mailing Address - Phone:408-261-2222
Mailing Address - Fax:408-261-0310
Practice Address - Street 1:3151 OLIN AVE STE 100
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95117-1635
Practice Address - Country:US
Practice Address - Phone:408-261-2222
Practice Address - Fax:408-261-0310
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 24532111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0245320OtherBLUE SHIELD PIN
CADC0245320Medicare PIN
CADC0245320OtherBLUE SHIELD PIN