Provider Demographics
NPI:1588609721
Name:THOMAS TAYERI M.D. INC.
Entity Type:Organization
Organization Name:THOMAS TAYERI M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYERI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-321-0958
Mailing Address - Street 1:1805 EL CAMINO REAL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-1162
Mailing Address - Country:US
Mailing Address - Phone:650-324-9200
Mailing Address - Fax:650-326-5793
Practice Address - Street 1:1805 EL CAMINO REAL
Practice Address - Street 2:SUITE 100
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1162
Practice Address - Country:US
Practice Address - Phone:650-324-9200
Practice Address - Fax:650-326-5793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG072133207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G721330Medicaid
CAF90629Medicare UPIN
CA00G721330Medicaid