Provider Demographics
NPI:1801833033
Name:TAIFER, JOSHUA (MD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:TAIFER
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 1:1516 COTNER AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-3303
Mailing Address - Country:US
Mailing Address - Phone:310-445-2951
Mailing Address - Fax:310-479-1459
Practice Address - Street 1:1516 COTNER AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-3303
Practice Address - Country:US
Practice Address - Phone:310-445-2951
Practice Address - Fax:310-479-1459
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG389302085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G389300OtherBLUE SHIELD
CAGR0106039Medicaid
CA00G389300Medicaid
CA00G389300Medicaid
CAWG38930DMedicare PIN
CAWG38930QMedicare PIN
CAWG38930MMedicare PIN
CAAO750XMedicare PIN
CA00G389303Medicare PIN
CA00G389300OtherBLUE SHIELD
CAWG38930HMedicare PIN
CAWG38930IMedicare PIN
CAWG38930NMedicare PIN
CAWG38930EMedicare PIN
CAWG38930KMedicare PIN
CA00G389302Medicare PIN
CAA89673Medicare UPIN
CAAO750ZMedicare PIN
CAGR0106039Medicaid
CAWG38930JMedicare PIN
CAWG38930PMedicare PIN
CABF873ZMedicare PIN
CAWG38930LMedicare PIN