Provider Demographics
NPI:1417259037
Name:DAVID N. TASHJIAN, M.D. INC
Entity Type:Organization
Organization Name:DAVID N. TASHJIAN, M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:NORMAN
Authorized Official - Last Name:TASHJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-431-2397
Mailing Address - Street 1:1290 E SPRUCE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3371
Mailing Address - Country:US
Mailing Address - Phone:559-431-2397
Mailing Address - Fax:559-447-1325
Practice Address - Street 1:1290 E SPRUCE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3371
Practice Address - Country:US
Practice Address - Phone:559-431-2397
Practice Address - Fax:559-447-1325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC41281207NI0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA37562Medicare UPIN
CA00C412810Medicare PIN