Provider Demographics
NPI:1538368014
Name:BAHMANPOUR, KAVEH (MD)
Entity type:Individual
Prefix:DR
First Name:KAVEH
Middle Name:
Last Name:BAHMANPOUR
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 1:3023 BUNKER HILL ST STE 106
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-5701
Mailing Address - Country:US
Mailing Address - Phone:858-270-0010
Mailing Address - Fax:858-270-0011
Practice Address - Street 1:3023 BUNKER HILL ST STE 106
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-5701
Practice Address - Country:US
Practice Address - Phone:858-270-0010
Practice Address - Fax:858-270-0011
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA109450207QG0300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine