Provider Demographics
NPI:1508983057
Name:BAHIN-AEIN, ASHKAN (MD)
Entity type:Individual
Prefix:DR
First Name:ASHKAN
Middle Name:
Last Name:BAHIN-AEIN
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:PO BOX 950
Mailing Address - Street 2:
Mailing Address - City:WHITERIVER
Mailing Address - State:AZ
Mailing Address - Zip Code:85941-0950
Mailing Address - Country:US
Mailing Address - Phone:775-223-5935
Mailing Address - Fax:
Practice Address - Street 1:860 W. HOSPITAL DR./PO BOX 860
Practice Address - Street 2:
Practice Address - City:WHITERIVER
Practice Address - State:AZ
Practice Address - Zip Code:85941
Practice Address - Country:US
Practice Address - Phone:928-338-4911
Practice Address - Fax:928-352-3503
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ51941207R00000X
NV13169207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
12162269OtherCAQH
1508983057OtherNPI
NVCM893XMedicare PIN