Provider Demographics
NPI:1679766745
Name:TAHERI, HAMED (MD)
Entity Type:Individual
Prefix:DR
First Name:HAMED
Middle Name:
Last Name:TAHERI
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 1:1045 ATLANTIC AVE STE 512
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-3422
Mailing Address - Country:US
Mailing Address - Phone:562-435-0862
Mailing Address - Fax:562-435-0863
Practice Address - Street 1:1045 ATLANTIC AVE STE 512
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3422
Practice Address - Country:US
Practice Address - Phone:562-435-0862
Practice Address - Fax:562-435-0863
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4463012086S0129X, 208600000X
NY274616208600000X
VA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103082942Medicaid
MD112351300Medicaid
CAA138318OtherLICENSE
PA478323Medicare PIN