Provider Demographics
NPI:1306972690
Name:HALEH BAKSHANDEH MD PA
Entity type:Organization
Organization Name:HALEH BAKSHANDEH MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HALEH
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKSHANDEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-205-0230
Mailing Address - Street 1:9730 WILSHIRE BLVD
Mailing Address - Street 2:SUITE # 115
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-2022
Mailing Address - Country:US
Mailing Address - Phone:310-274-7623
Mailing Address - Fax:310-274-1032
Practice Address - Street 1:9730 WILSHIRE BLVD
Practice Address - Street 2:SUITE # 115
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-2022
Practice Address - Country:US
Practice Address - Phone:310-274-7623
Practice Address - Fax:310-274-1032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89344207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty