Provider Demographics
NPI:1578594206
Name:JOHN TALIEH MEDICAL CORPORATION
Entity Type:Organization
Organization Name:JOHN TALIEH MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YAHYA
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:TALIEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-522-0600
Mailing Address - Street 1:PO BOX 577134
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95357-7134
Mailing Address - Country:US
Mailing Address - Phone:209-522-0600
Mailing Address - Fax:209-491-0116
Practice Address - Street 1:1401 SPANOS CT
Practice Address - Street 2:SUITE 203
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-2810
Practice Address - Country:US
Practice Address - Phone:209-522-0600
Practice Address - Fax:209-491-0116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73331174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A733310Medicaid
CA00A733310Medicaid
00A733310Medicare ID - Type Unspecified