Provider Demographics
NPI:1174579700
Name:BAHN, DUKE K (MD)
Entity type:Individual
Prefix:DR
First Name:DUKE
Middle Name:K
Last Name:BAHN
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 1:5855 OLIVAS PARK DR
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-7672
Mailing Address - Country:US
Mailing Address - Phone:805-667-2801
Mailing Address - Fax:805-667-2865
Practice Address - Street 1:168 N BRENT ST
Practice Address - Street 2:#402
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2817
Practice Address - Country:US
Practice Address - Phone:888-234-0004
Practice Address - Fax:888-641-3965
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC507522085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C507520OtherBLUE SHIELD OF CA
CA00C507520Medicaid
CA300132117OtherRR MEDICARE
CABI663YMedicare PIN
CABI663ZMedicare PIN
B48731Medicare UPIN
CA300132117OtherRR MEDICARE
CAWC50752AMedicare PIN