Provider Demographics
NPI:1376823153
Name:TAFTIAN, DAVID (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:TAFTIAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18040 SHERMAN WAY STE 304
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-4656
Mailing Address - Country:US
Mailing Address - Phone:415-483-0219
Mailing Address - Fax:802-219-4987
Practice Address - Street 1:18040 SHERMAN WAY STE 304
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-4656
Practice Address - Country:US
Practice Address - Phone:310-721-4395
Practice Address - Fax:818-338-2528
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-24
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH79855208100000X
CA20A14852208100000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB263068Medicare PIN