Basic Information
Provider Information
NPI: 1619230521
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SADIGHI
FirstName: BABAK
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
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OtherFirstName:  
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Mailing Information
Address1: 9127 W RUSSELL RD
Address2: STE 110
City: LAS VEGAS
State: NV
PostalCode: 891481253
CountryCode: US
TelephoneNumber: 7814077713
FaxNumber: 7814070998
Practice Location
Address1: 690 CANTON ST
Address2: STE 325
City: WESTWOOD
State: MA
PostalCode: 020902324
CountryCode: US
TelephoneNumber: 7814077713
FaxNumber: 7814070998
Other Information
ProviderEnumerationDate: 06/18/2012
LastUpdateDate: 08/13/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208600000X125061022ILN Allopathic & Osteopathic PhysiciansSurgery 
207L00000XMD15549RIY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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