Provider Demographics
NPI:1922144450
Name:DANIEL TAHERI MD INC
Entity Type:Organization
Organization Name:DANIEL TAHERI MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TAHERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-947-9000
Mailing Address - Street 1:PO BOX 16297
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90209-2297
Mailing Address - Country:US
Mailing Address - Phone:800-991-6448
Mailing Address - Fax:661-974-8669
Practice Address - Street 1:631 W AVENUE Q
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-3892
Practice Address - Country:US
Practice Address - Phone:661-974-8666
Practice Address - Fax:661-266-8751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16137Medicare PIN
CAG26246Medicare UPIN
CAZZZ24737ZMedicare PIN
CAZZZ24739ZMedicare PIN
CA00G804451OtherMEDICARE PPIN
CAWG80445BOtherMEDICARE PPIN
CA00G804450OtherMEDICARE PPIN