Provider Demographics
NPI:1700267960
Name:GOLSHAHI, BAHAR (DPM)
Entity type:Individual
Prefix:DR
First Name:BAHAR
Middle Name:
Last Name:GOLSHAHI
Suffix:
Gender:F
Credentials:DPM
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Mailing Address - Street 1:32565 B GOLDEN LANTERN STREET
Mailing Address - Street 2:PMB 341
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629
Mailing Address - Country:US
Mailing Address - Phone:949-272-0007
Mailing Address - Fax:949-272-0006
Practice Address - Street 1:26800 CROWN VALLEY PARKWAY
Practice Address - Street 2:STE 420
Practice Address - City:MISSIONVIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691
Practice Address - Country:US
Practice Address - Phone:949-272-0007
Practice Address - Fax:949-272-0006
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-13
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAE5490213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist