Provider Demographics
NPI:1457359978
Name:BAGHERI, SHAHIN (MD)
Entity type:Individual
Prefix:DR
First Name:SHAHIN
Middle Name:
Last Name:BAGHERI
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 1:8510 BALBOA BLVD
Mailing Address - Street 2:STE 150
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-5810
Mailing Address - Country:US
Mailing Address - Phone:818-654-3400
Mailing Address - Fax:818-654-3417
Practice Address - Street 1:191 S BUENA VISTA ST.
Practice Address - Street 2:STE 420
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4551
Practice Address - Country:US
Practice Address - Phone:818-557-7399
Practice Address - Fax:818-848-1543
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA34357207RR0500X
CAA77192207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA35155OtherBLUE CROSS/BLUE SHIELD
IA0290809Medicaid
IA35155OtherBLUE CROSS/BLUE SHIELD
IA0290809Medicaid