Provider Demographics
NPI:1235441619
Name:TAHANI, MOHSEN (MD)
Entity Type:Individual
Prefix:
First Name:MOHSEN
Middle Name:
Last Name:TAHANI
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 1:4125 STATE LINE RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-4423
Mailing Address - Country:US
Mailing Address - Phone:816-655-5270
Mailing Address - Fax:816-655-5395
Practice Address - Street 1:801 NW SAINT MARY DR STE 210
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-2539
Practice Address - Country:US
Practice Address - Phone:818-300-2998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-13
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY262262208100000X
NY3334618208100000X
CAA138468208100000X
KS04-36758208100000X
MO2016026450208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation