Provider Demographics
NPI:1346249539
Name:TAHERY, MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:TAHERY
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:PO BOX 16376
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90209-2376
Mailing Address - Country:US
Mailing Address - Phone:818-265-9499
Mailing Address - Fax:818-548-0447
Practice Address - Street 1:10884 SANTA MONICA BLVD STE 400
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-7639
Practice Address - Country:US
Practice Address - Phone:818-296-9499
Practice Address - Fax:818-548-0447
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG78228174400000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG78228OtherMEDICAL LICENSE
CA1346249539OtherNPI NUMBER
CA1346249539OtherNPI NUMBER
CAF87040Medicare UPIN