Provider Demographics
NPI:1710040936
Name:MAGED A. TANIOS, MD, INC
Entity Type:Organization
Organization Name:MAGED A. TANIOS, MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAGED
Authorized Official - Middle Name:
Authorized Official - Last Name:TANIOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-424-8000
Mailing Address - Street 1:PO BOX 32025
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90832-2025
Mailing Address - Country:US
Mailing Address - Phone:562-424-8000
Mailing Address - Fax:562-424-8006
Practice Address - Street 1:3605 LONG BEACH BLVD
Practice Address - Street 2:#405
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-4013
Practice Address - Country:US
Practice Address - Phone:562-424-8000
Practice Address - Fax:562-424-8006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18255Medicare ID - Type UnspecifiedPROVIDER NUMBER