Provider Demographics
NPI:1265528970
Name:TAYANI, RAMIN (MD)
Entity type:Individual
Prefix:DR
First Name:RAMIN
Middle Name:
Last Name:TAYANI
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 1:653 CAMINO DE LOS MARES, STE 107
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673
Mailing Address - Country:US
Mailing Address - Phone:949-489-2218
Mailing Address - Fax:949-496-3604
Practice Address - Street 1:653 CAMINO DE LOS MARES, STE 107
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673
Practice Address - Country:US
Practice Address - Phone:949-489-2218
Practice Address - Fax:949-496-3604
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69679207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A696790OtherBLUE SHIELD PROVIDER #
CA00A696791Medicaid
CA330908874OtherTAX ID#
CAH08912Medicare UPIN
CA330908874OtherTAX ID#
CA00A696790Medicare ID - Type UnspecifiedNORTHERN MEDICARE