Provider Demographics
NPI:1285071894
Name:BANGASH, KAYHAN (MD)
Entity type:Individual
Prefix:
First Name:KAYHAN
Middle Name:
Last Name:BANGASH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 EMILY WAY
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93637-5647
Mailing Address - Country:US
Mailing Address - Phone:559-395-4009
Mailing Address - Fax:559-664-5069
Practice Address - Street 1:924 EMILY WAY
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-5647
Practice Address - Country:US
Practice Address - Phone:559-395-4009
Practice Address - Fax:559-664-5069
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-23
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE9113207Q00000X
390200000X
CAA170260207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine