Provider Demographics
NPI:1073856837
Name:TAHERI, NIMA (MD)
Entity Type:Individual
Prefix:
First Name:NIMA
Middle Name:
Last Name:TAHERI
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 1:7700 IRVINE CENTER DR STE 800
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3047
Mailing Address - Country:US
Mailing Address - Phone:949-236-7127
Mailing Address - Fax:949-449-8020
Practice Address - Street 1:7700 IRVINE CENTER DR STE 800
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3047
Practice Address - Country:US
Practice Address - Phone:949-236-7127
Practice Address - Fax:949-449-8020
Is Sole Proprietor?:No
Enumeration Date:2013-03-30
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA131464208M00000X
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA131464Medicaid