Provider Demographics
NPI:1316963713
Name:BAHADOR, AFSHIN (MD)
Entity type:Individual
Prefix:DR
First Name:AFSHIN
Middle Name:
Last Name:BAHADOR
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5030 CAMINO DE LA SIESTA STE 202
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3118
Mailing Address - Country:US
Mailing Address - Phone:858-455-5524
Mailing Address - Fax:858-587-9377
Practice Address - Street 1:9095 RIO SAN DIEGO DR STE 425
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1679
Practice Address - Country:US
Practice Address - Phone:858-455-5524
Practice Address - Fax:858-587-9377
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA653962086X0206X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA004653960Medicaid
CA113908Medicare UPIN
CAWA65396GMedicare PIN