diff --git a/litellm/main.py b/litellm/main.py
index 23922e3c8bf..ba410746dad 100644
--- a/litellm/main.py
+++ b/litellm/main.py
@@ -7247,6 +7247,24 @@ def stream_chunk_builder(  # noqa: PLR0915
                 usage, "cost", logging_obj._response_cost_calculator(result=response)
             )
 
+        # Propagate _hidden_params from streaming chunks to final response
+        # This ensures headers like llm_provider-x-ms-region are preserved for callbacks
+        # Fixes: https://github.com/BerriAI/litellm/issues/19930
+        if chunks and hasattr(chunks[0], "_hidden_params"):
+            first_chunk_hidden_params = getattr(chunks[0], "_hidden_params", {})
+            if first_chunk_hidden_params:
+                if not hasattr(response, "_hidden_params"):
+                    response._hidden_params = {}
+                # Copy additional_headers if present
+                if "additional_headers" in first_chunk_hidden_params:
+                    response._hidden_params["additional_headers"] = (
+                        first_chunk_hidden_params["additional_headers"]
+                    )
+                # Copy other hidden params that should be preserved
+                for key in ["model_id", "api_base", "custom_llm_provider"]:
+                    if key in first_chunk_hidden_params:
+                        response._hidden_params[key] = first_chunk_hidden_params[key]
+
         return response
     except Exception as e:
         verbose_logger.exception(
diff --git a/tests/test_litellm/test_streaming_headers_propagation.py b/tests/test_litellm/test_streaming_headers_propagation.py
new file mode 100644
index 00000000000..f17972f43b0
--- /dev/null
+++ b/tests/test_litellm/test_streaming_headers_propagation.py
@@ -0,0 +1,126 @@
+"""
+Test that streaming response headers are propagated to the final assembled response.
+Fixes: https://github.com/BerriAI/litellm/issues/19930
+"""
+
+import pytest
+from unittest.mock import MagicMock
+
+import litellm
+from litellm import ModelResponse
+from litellm.main import stream_chunk_builder
+from litellm.types.utils import ModelResponseStream, StreamingChoices, Delta
+
+
+class TestStreamingHeadersPropagation:
+    """Tests for streaming headers propagation to final response."""
+
+    def test_stream_chunk_builder_propagates_additional_headers(self):
+        """
+        Test that stream_chunk_builder copies _hidden_params["additional_headers"]
+        from chunks to the final assembled response.
+        """
+        # Create mock streaming chunks with _hidden_params containing headers
+        chunk1 = ModelResponseStream(
+            id="test-id",
+            model="gpt-4",
+            choices=[StreamingChoices(index=0, delta=Delta(content="Hello "))],
+        )
+        chunk1._hidden_params = {
+            "additional_headers": {
+                "llm_provider-x-ms-region": "eastus",
+                "llm_provider-x-ratelimit-remaining-tokens": "10000",
+            },
+            "model_id": "test-model-id",
+            "api_base": "https://api.openai.com",
+            "custom_llm_provider": "azure",
+        }
+
+        chunk2 = ModelResponseStream(
+            id="test-id",
+            model="gpt-4",
+            choices=[
+                StreamingChoices(index=0, delta=Delta(content="World"), finish_reason="stop")
+            ],
+        )
+        chunk2._hidden_params = {}
+
+        chunks = [chunk1, chunk2]
+
+        # Call stream_chunk_builder
+        result = stream_chunk_builder(chunks=chunks, messages=[{"role": "user", "content": "Hi"}])
+
+        # Verify the result has _hidden_params with headers
+        assert result is not None
+        assert hasattr(result, "_hidden_params")
+        assert "additional_headers" in result._hidden_params
+
+        # Check that the specific headers are preserved
+        additional_headers = result._hidden_params["additional_headers"]
+        assert additional_headers.get("llm_provider-x-ms-region") == "eastus"
+        assert additional_headers.get("llm_provider-x-ratelimit-remaining-tokens") == "10000"
+
+        # Check other hidden params are also copied
+        assert result._hidden_params.get("model_id") == "test-model-id"
+        assert result._hidden_params.get("api_base") == "https://api.openai.com"
+        assert result._hidden_params.get("custom_llm_provider") == "azure"
+
+    def test_stream_chunk_builder_handles_missing_hidden_params(self):
+        """
+        Test that stream_chunk_builder works correctly when chunks don't have _hidden_params.
+        """
+        # Create chunks without _hidden_params
+        chunk1 = ModelResponseStream(
+            id="test-id",
+            model="gpt-4",
+            choices=[StreamingChoices(index=0, delta=Delta(content="Hello "))],
+        )
+        # Don't set _hidden_params
+
+        chunk2 = ModelResponseStream(
+            id="test-id",
+            model="gpt-4",
+            choices=[
+                StreamingChoices(index=0, delta=Delta(content="World"), finish_reason="stop")
+            ],
+        )
+
+        chunks = [chunk1, chunk2]
+
+        # Call stream_chunk_builder - should not raise
+        result = stream_chunk_builder(chunks=chunks, messages=[{"role": "user", "content": "Hi"}])
+
+        # Verify result is valid
+        assert result is not None
+
+    def test_stream_chunk_builder_handles_empty_additional_headers(self):
+        """
+        Test that stream_chunk_builder handles empty additional_headers gracefully.
+        """
+        chunk1 = ModelResponseStream(
+            id="test-id",
+            model="gpt-4",
+            choices=[StreamingChoices(index=0, delta=Delta(content="Hello "))],
+        )
+        chunk1._hidden_params = {
+            "model_id": "test-id",
+            # No additional_headers
+        }
+
+        chunk2 = ModelResponseStream(
+            id="test-id",
+            model="gpt-4",
+            choices=[
+                StreamingChoices(index=0, delta=Delta(content="World"), finish_reason="stop")
+            ],
+        )
+
+        chunks = [chunk1, chunk2]
+
+        result = stream_chunk_builder(chunks=chunks, messages=[{"role": "user", "content": "Hi"}])
+
+        assert result is not None
+        assert hasattr(result, "_hidden_params")
+        # additional_headers should not be present if it wasn't in the source
+        assert "additional_headers" not in result._hidden_params or result._hidden_params.get("additional_headers") is None
+