Provider Demographics
NPI:1053725978
Name:BAHAR IMMUNIZATION CENTER LLC
Entity type:Organization
Organization Name:BAHAR IMMUNIZATION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SIAVASH
Authorized Official - Middle Name:
Authorized Official - Last Name:TEHRANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-878-2044
Mailing Address - Street 1:5200 MITCHEDALLE SUITE F-27
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77092
Mailing Address - Country:US
Mailing Address - Phone:832-878-2044
Mailing Address - Fax:
Practice Address - Street 1:5200 MITCHELLDALE ST
Practice Address - Street 2:F-27
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092-7206
Practice Address - Country:US
Practice Address - Phone:832-878-2044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-18
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty