Provider Demographics
NPI:1114290889
Name:TAHERI, KHOJASTEH KATHY
Entity Type:Individual
Prefix:MRS
First Name:KHOJASTEH
Middle Name:KATHY
Last Name:TAHERI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2534 WILD DUNES CT
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60503-5648
Mailing Address - Country:US
Mailing Address - Phone:630-499-0215
Mailing Address - Fax:630-499-0215
Practice Address - Street 1:2534 WILD DUNES CT
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60503-5648
Practice Address - Country:US
Practice Address - Phone:630-499-0215
Practice Address - Fax:630-499-0215
Is Sole Proprietor?:No
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography
No246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography
No2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular Sonography