Provider Demographics
NPI:1649632696
Name:BACLIG, NIKITA VASHI (MD)
Entity type:Individual
Prefix:MS
First Name:NIKITA
Middle Name:VASHI
Last Name:BACLIG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NIKITA
Other - Middle Name:
Other - Last Name:VASHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5767 W CENTURY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:310-301-5200
Mailing Address - Fax:
Practice Address - Street 1:2020 SANTA MONICA BLVD STE 580
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2000
Practice Address - Country:US
Practice Address - Phone:310-829-5471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60874954207R00000X
CA168697207R00000X
CAA168697207RX0202X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1649632696Medicaid